Objective To construct a relative value scale for intraoperative nursing workload, providing a reference for establishing a scientific, rational, comprehensive, and fair quantitative tool for operating room nursing workload and a performance evaluation scheme for operating room nursing.Methods Based on the theoretical framework of the Resource-Based Relative Value Scale (RBRVS), surgical procedures were preliminarily identified through systematic literature retrieval and group discussions. The relative value scale for surgical assisting nursing workload was revised through two rounds of Delphi expert consultation. The analytic hierarchy process and K-Means clustering were used to calculate the difficulty coefficients and difficulty levels of the surgical procedures. Results The weights of the four evaluation dimensions for surgical procedures （operation duration, technical difficulty, physical exertion, and risk level） were 0.167, 0.453, 0.262, and 0.118, respectively (consistency ratio＜0.10). The final relative value scale included 160 surgical procedures, and the difficulty coefficients ranged from 55.63 to 600.25, which includes 19 high-difficulty procedures, 59 medium-difficulty ones, and 82 low-difficulty ones. The scores across all evaluation dimensions showed statistically significant differences between procedures of different difficulty levels (all P<0.05). Conclusion The constructed relative value scale for intraoperative nursing workload features a comprehensive evaluation system, and its difficulty classification aligns with clinical practice. It can be used to evaluate nursing workload in the operating room. This study provides a theoretical basis for subsequently developing a scientific performance distribution plan and rationally allocating human resources in operating room nursing.