This is the first study that investigated the current situation of the information literacy of nurses in multi-center hospitals in China. Through the investigation of 3,011 nurses, we found that the level of information literacy of nurses in Shaanxi Province was low, and there was a big gap between nurses' information literacy in hospitals of different levels (P<0.001) which shows that it is necessary to speed up the cultivation of nurses' information literacy, especially for nurses in primary hospitals.
The information literacy of nurses can help them effectively obtain valuable information in clinical nursing work and make correct information decision timely, which is closely related to the quality of clinical nursing service [20, 21]. Studies have found that good information literacy of nurses is conducive to promoting the health of patients [22, 23]. Therefore, it is necessary and meaningful to make clear the status of nurses' information literacy, find out the influencing factors, and give targeted guidance. However, in our study, the level of information literacy of nurses was low; We can see from Table 1 that there are significant differences in the educational background, living conditions, marital status, professional titles, learning situation, and the mastery of information retrieval knowledge of nurses among these hospitals (P<0.001). At present, most of the medical hospitals in China have carried on informatization construction , but there is a big gap between hospitals of different levels , especially primary hospitals and clinics, which are short of the construction of quality management system of medical information, as well as information of medical quality control hardware facilities [26, 27]. This was an important reason for the low level of information literacy of nurses
In the multiple linear regression equation in Table 5, we also found that age and education background were other important factors affecting nurses' information literacy, which was similar to Nowrouzi's  findings that highly educated nurses have better working ability, so they can better master information skills and have a high level of information literacy. Compared with older nurses, younger nurses were more likely to apply information equipment and master information knowledge and skills, so their information literacy level was higher. Therefore, in the process of information literacy training, educators should pay more attention to the improvement of the ability of elderly and low degree nurses.
In our study, 29% of nurses participated in information literacy training, higher than 20% reported in Singapore  which was related to the Healthy China 2030 strategy to speed up the construction of medical team and personnel training . A longitudinal study on nurse information training found that nurses' ability of information seeking and management was significantly improved after five months of training . Therefore, it is necessary to strengthen the training of nurses' information literacy . Nurses who had received relevant information training thought that it was adequate to meet the needs of clinical nursing work . The government should actively organize information literacy training, promote clinical continuing education of information literacy, pay attention to the teaching of information literacy in the training process of nursing students [32-35] strengthen information support for hospitals, especially primary hospitals, and provide financial support and hardware facilities .
In order to speed up the process of informatization, nursing managers should fully realize the importance of information literacy in clinical nursing work [37, 38]. Primary hospitals in China are mainly located in township hospitals and community health service stations, with low information level and lagging medical development [39, 40]. The score of information literacy of primary nurses in these hospitals was far lower than that of the secondary and tertiary hospitals. With the proposal of healthy China strategy; to promote the health level of the whole people [41, 42], it is necessary to promote the information construction, improve the electronic medical records of residents, and construct health records and information network in primary hospital .
On the other hand, nurses should strengthen the accumulation of information literacy in clinical nursing work which is consistent with Jindal’s  findings that there was an internal relationship between nurses' information literacy and reading behavior. Nurses should keep good reading habits in spare time, especially reading more about the advanced medical literature. With the development of evidence-based nursing which has higher requirements for literature index and retrieval , it is necessary for nurses to master good literature retrieval ability to carry out evidence-based nursing in clinical work . Application of information index is one of the important ability of nurses’ information literacy, through which nurses can learn the latest frontier dynamic knowledge in professional field [46, 47]. Therefore, nurses themselves should strengthen professional learning and skills development, and constantly improve the level of information literacy.
There are some limitations in this study. First of all, this study was only limited to nurses in Shaanxi Province. Affected by geographical location, economic development and medical level, it can not represent the overall information literacy level of Chinese nurses. Moreover, the questionnaire was self-reported by nurses, which has certain subjective bias. Therefore, further subjective and objective evaluation method in hospitals of different regional provinces and cities are required.