〔Abstract〕 Objective To explore the application effect of hierarchical responsibility system in perioperative nursing of ureteral calculi. Methods A total of 130 patients with ureteral calculi treated in the First Affiliated Hospital of Zhengzhou University from November 2020 to February 2022 who underwent holmium laser lithotripsy were randomly divided into a contral group and an observation group with 65 cases in each group. The control group was given routine perioperative nursing, and the observation group was given hierarchical responsibility nursing. The two groups were compared in terms of postoperative temperature, normal time of blood routine and urine routine, time of removing double J tube, length of hospital stay, incidence of complications (including perforation, urinary tract infection, hematuria and ureteral obstruction) and stress level before and after surgery. Results The times of body temperature, blood routine and urine routine recovery, double J tube removal and hospital stay in the observation group were shorter than those in the control group, the differences were statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that of the control group, and the difference was statistically significant (P < 0.05). 24 h after operation, the malondialdehyde (MDA) and cortisol (Cor) levels in the observation group were lower than those in the control group, while the superoxide dismutase (SOD) level was higher than that in the control group, with statistical significances (P < 0.05). Conclusion Perioperative nursing of ureteral calculi with graded responsibility system can promote postoperative recovery, reduce complications and reduce operative stress.