AbstractAimsTo describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks.DesignRetrospective study.MethodsThe study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single‐Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs.ResultsPatients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care.ConclusionsThe inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes.Implications for the profession and/or patient careHL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge.Patient or Public ContributionNo patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.