Abstract: Objective To explore the effect of optimizing emergency nursing process on neurological deficit and daily living ability in patients with acute cerebral infarction (ACI). Methods Totally 88 patients with ACI who were diagnosed and treated in Shaoxing people's hospital from January 2017 to June 2018 were selected and divided into observation group and control group with 44 cases in each group. The control group was treated with routine emergency nursing procedure, and the observation group was treated with optimizing emergency nursing process. Record and compare the times of doctor arrival, door to CT examination, door to CT report and door to needle (DTN) between the two groups. Compare the National Institutes of Health Stroke scale (NIHSS) score and Barthel index (BI) before and 24 hours after thrombolytic therapy between the two groups. Compare the first aid success rate, mortality rate and disability rate between the two groups. Results The times of doctor arrival, door to CT examination, door to CT report and DTN in the observation group were significantly shorter than those in the control group (all P<0.05). Before thrombolytic therapy, there was no significant difference in NIHSS score and BI between the two groups (all P>0.05). The NIHSS score of the observation group was significantly lower than that of the control group 24 hours after thrombolysis (P<0.05), and the BI of the observation group was significantly higher than that of the control group 24 hours after thrombolysis (P<0.05). The success rate of first aid in the observation group was 81.82%,which was significantly higher than 59.09% in the control group (P<0.05), but there was no significant difference in mortality rate and disability rate between the two groups (all P>0.05). Conclusion The optimization emergency nursing process can shorten the time of first aid to ACI patients, improve the success rate of emergency treatment, and improve the neurological deficit and daily living ability of patients.