Objective To develop a questionnaire for assessing the soft environment of nursing work in traditional Chinese medicine (TCM) hospitals under the DRG payment system and to evaluate its reliability and validity, thereby providing a reliable tool for assessing the impact of DRG payment on the nursing work environment. Methods Drawing upon the patient safety system engineering model within human factors and ergonomics, and research findings concerning work performance influencing factors, this study establishes its theoretical basis, a questionnaire was developed through literature review, expert consultation, and group discussions. Using a convenience sampling method, a survey was conducted among 452 nursing staff from four TCM hospitals in Zhejiang Province to test the reliability and validity of the questionnaire. Results The Nursing Work Soft Environment Assessment Questionnaire in TCM Hospitals under the DRG Payment System includes 7 dimensions totaling 28 items. Exploratory factor analysis extracted seven common factors, with a cumulative variance contribution rate of 77.096%. The overall Cronbach′s α coefficient of the questionnaire was 0.969, and the split-half reliability was 0.908. The scale-level content validity index （S-CVI/UA) was 0.929, and the item-level content validity index ranged from 0.875 to 1.000. Confirmatory factor analysis constructed a first-order seven-factor model, showing good model fit with χ2/df=2.341, RMSEA=0.071, GFI=0.831, CFI=0.942, NFI=0.904, and NNFI=0.933. The square roots of AVE for each dimension were significantly greater than the correlation coefficients, and there were significant correlations among the dimensions (all P<0.05). Conclusion The Nursing Work Soft Environment Assessment Questionnaire in TCM Hospitals under the DRG Payment System demonstrates good reliability and validity and can be used to evaluate the impact of DRG payment on the nursing work environment in TCM hospitals.