Objective To objectively and fairly reflect value of nurses′ work by identifying nursing care items and their performance rewards in department of internal medicine. Methods Based on the RBRVS theory, literature review and expert consultation followed the Delphi process were conducted to develop a workload oriented nursing care item system and to determine performance reward of each item in department of internal medicine. Results Eighty-eight items were identified, with nursing diagnosis and treatment being 35 items, nursing operations being 44 items, and physician-nurse collaborative operations being 9 items. The relative value scale (RVS) ratio, score for reasonableness of the RVS ratio and performance reward of the item were also determined. Conclusion Nursing items and their performance rewards identified in this study can be used in performance appraisal of nurses in department of internal medicine, thus to reflect value of nurses′ work.