Objective To explore the effect of hierarchical authorization of nurses in management of iatrogenic skin injury in hospita-lized patients. Methods Inpatients at risk of iatrogenic skin injury were divided into a control group (173 237 cases in 2018) and an observation group (205 511 cases in 2019 and 236 742 cases in 2021) in chronological order, respectively subjected to routine ma-nagement or management by hierarchically authorized nurses. Results After implementing hierarchical authorization of nurses in management of iatrogenic skin injury, 81 nurse specialists were trained and authorized.There were significant differences in the incidence rate, degree and outcomes of iatrogenic skin injury between the two groups （all P＜0.05）. Conclusion Implementation of hierarchical authorization of nurses could effectively reduce the incidence rate of iatrogenic skin injury in hospitalized patients, improve the outcome of skin injury, and improve the quality of nursing care.