Organizations have been more environmentally conscious in recent years, particularly since the sustainable development target was established worldwide. Consequently, scholars' attention has been drawn to the connection between green human resource management (GHRM) and organizational performance. This study aims to investigate the relationship between organizational performance and green human resource management at Nekemte Comprehensive Specialized Hospital (NCSH), a public hospital located in Nekemte City, east Wallagga zone, Oromia regional state, Ethiopia. Data was gathered using a closed-ended, five-point Likert questionnaire survey in order to meet the study's goals. All 223 questionnaire were received and analyzed using the structural equation modeling (SEM) method. Convergent and discriminant validity tests, as well as construct and composite reliability, were performed on the specified SEM model. The outcome of these tests showed that the SEM model's validity and reliability had been attained. Further, the SEM was checked for model fit indices and it was assured that the model is fit in all aspects. The SEM results revealed positive and significant effects of green reward and compensation (GRC) with a path coefficient of 0.41 (P<0.05) whereas green performance management and appraisal (GPMA) with a path coefficient of 0.48 (P<0.05) on organizational performance (OP) of Nekemte comprehensive specialized hospital. The structural model further revealed that green training and development (GTD) and green reward and compensation (GRC) have a significant effect on green performance management and appraisal (GPMA) with an estimated path coefficient of 0.49 (P<0.05) and 0.52 (P<0.05, respectively. The effect size analysis results indicated that GRC has the largest effect on organizational performance with an estimated path coefficient of 0.55 while GPMA has appeared with an estimated coefficient of 0.45 revealing a medium effect on OP. The result from the mediation analysis has indicated that GPMA has fully mediated between GTD and OP while it partially mediated between GRC and OP. From the econometric results, it is concluded that GHRM practices are positively contributing to the performance of the organization. The overall conclusion of the study is that there are limited GRHM practices that positively contribute to the performance of the hospital. The policy implication is that better organizational performance of the hospital demands the continuous effort of putting GRHM practices at the center of the organizational goal. Further, the dual contribution of GRC and the dual advantage of GPMA need to be well exploited.