Objective To construct a hierarchical training program for patient safety competence of operating room nurses and evaluate its preliminary application effect. Methods The first draft of the program was formulated based on literature review and questionnaire survey. From December 2024 to January 2025，the Delphi method was used to conduct two rounds of consultation with 16 experts in related fields，and the program was formed. From April 2025 to June 2025，42 nurses in the operating room of a tertiary grade A general hospital in Chongqing were trained based on the program. The results of comprehensive quantitative assessment of nurses，the changes in self-assessed scores of patient safety competence before and after training，and their satisfaction with the training were analyzed. Results The positive coefficients of experts in the two rounds of letter consultation were 94.1% and 100.0% respectively，the authority coefficient were 0.906 and 0.912 respectively，and the Kendall's W coefficients were 0.319 and 0.329 respectively（all P<0.001）. The final program was divided into basic training program and advanced training program，each included seven modules：training objects，training objectives，training content，training methods，class hour arrangement，training instructors，and training evaluation. The theoretical assessment score of the basic training group was（89.23±3.85），and the one-time pass rate of the skill assessment was 92%；the pass rates of case analysis reports and evidence-based project design books in the advanced training group were both 100%. The self-assessed scores of nurses’ patient safety competence after training was higher than those before the training（P<0.001），and nurses’ satisfaction with the program was 98%. Conclusion The hierarchical training program for patient safety competence of operating room nurses is scientific and reliable，which helps to improve the patient safety competence of operating room nurses，and can provide reference，basis and practical guidance for hospitals to carry out patient safety training for operating room nurses.