Background <p>Clinical decision-making in pediatric surgery is uniquely complex, shaped by children’s distinct pathophysiological characteristics, rapid disease progression, and heightened family expectations. Understanding the clinical decision-making capabilities of frontline medical staff and their underlying influencing factors is thus critical to optimizing pediatric surgical care quality. This study aimed to assess these decision-making abilities among frontline pediatric surgery personnel.</p> Methods <p>A cross-sectional study was conducted from June to July 2025, enrolling frontline staff from the pediatric surgery department of a tertiary children’s hospital in Jiangsu Province. Data were collected using the Clinical Decision-Making Nursing Scale (CDMNS). Clinical trial number: not applicable.</p> Results <p>A total of 246 frontline pediatric surgery staff were included. The mean total score for clinical decision-making ability was 142.60 ± 15.27. Among CDMNS dimensions, “clarifying goals and values” scored highest, while “seeking information or new information” was the weakest. Correlation analysis revealed significant positive associations between decision-making ability and age (<i>r</i> = 0.610), years of practice (<i>r</i> = 0.589), educational background (<i>r</i> = 0.604), professional title (<i>r</i> = 0.601), and clinical decision-making training experience (<i>r</i> = 0.645). Career development factors (age, tenure, education, professional title) and prior training were strongly correlated with decision-making ability, with training emerging as the strongest correlate (R²=0.598, F = 26.044, <i>P</i> &lt; 0.001).</p> Conclusion <p>Career development trajectories and targeted training appear to be important correlates of clinical decision‑making competence in pediatric surgery. Potential strategic interventions may include implementing stratified training systems and optimizing specialized information support, which could contribute to systematic improvements in decision quality.</p>