Objective To explore the effect of nurse grading supervision system for pressure ulcer prevention in neurosurgery department .Methods A total of 148 neurosurgery patients , enrolled from February 2012 to February 2013 , were taken as intervention group .The other 136 neurosurgery patients , enrolled from January 2011 to January 2012 , were taken as routine group .Two groups were given routine nursing care .The nurse grading supervision system was constructed in the intervention group .The nurse grading supervision system was for pressure ulcer prevention , which was established charge nurse-team leader-duty nurse.Results Three patients in the intervention group occurred pressure ulcer with an incidence of 2.03%.And 12 patients in the routine group occurred pressure ulcer with an incidence of 8.82%, and the difference was statistically significant (χ2 =4.308, P<0.05).Patient’s satisfaction rate was 98.0% in the intervention group and 91.2% in the routine group, and the difference was statistically significant (χ2 =4.308, P<0.05).The scores of operating skill and master of patient ’ s condition were (97.1 ±4.9) and (98.2 ±1.3), respectively, after the implementation of classification management , which were higher than (89.1 ±8.2) and (88.9 ±7.2), respectively, before the implementation,and the differences were statistically significant (t=9.873,14.843;P<0.01).Conclusions It is advisable to adopt nurse grading supervision system for pressure ulcer prevention in neurosurgery department .It can improve the nurse ’ s abilities of observation and nursing management , and decrease the incidence of pressure ulcer among neurosurgical patients .