Objective To investigate the current status of pay equity perception among operating room nurses in tertiary hospitals and to identify its influencing factors, aiming to provide references for developing targeted intervention strategies. Methods A survey was conducted among 540 operating room nurses from eight tertiary hospitals in Sichuan Province using a general data questionnaire, the Pay Equity Perception Scale for Operating Room Nurses in Public Hospitals, the Calling Scale, the Social Capital of Nursing Scale, and the Supervisor Developmental Feedback Scale. Results The sample scored (108.60±18.38) for pay equity perception.Whether the nurse was a certified operating room specialist nurse, whether assigned weekly night shifts, educational level, calling, workplace social capital, and supervisor developmental feedback were factors influencing pay equity perception (all P＜0.05), accounting for 40.2% of the total variance. Conclusion The pay equity perception among operating room nurses in tertiary hospitals is at a moderately high level and is influenced by multiple factors.Special attention should be paid to certified operating room specialist nurses, nurses on weekly night shifts, and those with a master′s degree or above.Interventions such as enhancing calling and workplace social capital and providing developmental feedback may help improve operating room nurses′ perception of pay equity.