Background: The nurses’ performance in providing nursing services is one of the important aspects that become a measure of the success of quality service. Quality nursing services related to moral distress and work engagement. Object: To determine the influence of moral distress and work engagement on the nurses’ performance at the Deli Serdang Regional General Hospital. Methods: The study was an analytic survey with a cross-sectional study design. 126 nurses were the sample. The study wasusing cluster techniques and random sampling. Data analyzed using a multiple logistic regression test. Results: the study indicated that there was an effect on moral distress with a p-value of 0.0001 and work engagement [vigor (p=0.002), dedication (p=0.002), and absorption (p=0.0001)]means that moral distress and work engagement affected nurses’ performance, meanwhile the result of multivariate analysis showed that the most dominant variable affecting nurses’ performance was moral distress with Exp. (B) 10.256. Conclusion: It is recommended to improve and maintain the quality of nursing services following the standards of nursing care, increase the spirit of high morale at work to increase the quality of performance, increase work dedication to achieve better performance, and increase the concentration of nurses and are serious in carrying out nursing care.