Objective To construct a index system of economic management competency of head nurses, and provide a reference for cultivating and improving their economic management competency.Methods Based on the iceberg model, a draft competency index system of head nurses′ economic management was formulated through literature analysis and semi-structured interviews, then it was improved via a two-round expert consultation from March to May 2024, during which the index weight was determined by analytic hierarchy process.Results In the two rounds of expert consultation, the response rates were 100.0% and 95.0%, the expert authority coefficients were 0.88 and 0.90, and the Kendall coordination coefficients were 0.226 and 0.392, respectively (both P＜0.05).The final economic management competency index system of head nurses included 4 first-level indicators (basic knowledge, job skills, vocational ability, and comprehensive quality), 13 second-level indicators, and 41 third-level indicators.Conclusion The constructed economic management competency index system of head nurses is scientific and reliable, it provides support for head nurses training in hospitals and helps to improve the quality and economic effectiveness of nursing services.