Objective To construct a nursing difficulty evaluation index system for inpatients, and to provide a tool for assessing nursing workload accurately. Methods The nursing difficulty evaluation index system for inpatients was preliminarily formulated through literature review and semistructured interviews, then a 2round Delphi study was conducted among 28 experts to collect their opinions about the evaluation index system. Results〖WTBZ〗 The final evaluation index system contained 6 first level indicators (illness severity, selfcare ability of daily living, mental health status, compliance, social support status and expectations) and 21 second level indicators. Experts′response rate was 100%, experts′authority coefficient was 0.840, and the Kendall coefficients of concordance was 0.462 and 0.414 for the first and second level indicators (P<0.01 for both). Conclusion The constructed nursing difficulty evaluation index system for inpatients has high credibility, and it could be used for evaluating nursing workload accurately after further verification.