Abstract: Objective To explore the effect of risk nursing in the treatment of severe craniocerebral injury by controlled step intracranial decompression. Methods A total of 92 patients with severe craniocerebral injury from March 2018 to March 2019 were randomly divided into two groups. The control group received routine nursing and the observation group received risk nursing based on the control group. The incidence of risk events, prognosis after 6 months, surgical results, complications, intracranial pressure, delirium rating scale(DRS) and NIH stroke scale(NIHSS) scores were compared between the two groups. Results The incidence of postoperative risk events in the observation group was 10.4%(5/48), which was lower than that in the control group(33.3%, 16/48), χ²=7.375, P<0.05. The good prognosis rate in the observation group was 81.3%(39/48), which was better than that in the control group(62.5%, 30/48), χ²=4.174, P<0.05. The operation time, hospitalization days and bleeding volume in the observation group were lower than those in the control group(all P<0.05). The complication rate was 6.3%(3/48), which was lower than that of the control group(20.8%, 10/48), χ²=4.360, P<0.05. The intracranial pressure, DRS and NIHSS scores of the observation group were lower than those of the control group(all P<0.05). Conclusion For patients with severe craniocerebral injury, risk nursing can reduce the incidence of risk events and complications and improve the safety of treatment. Meanwhile, intracranial pressure can be improved, DRS and NIHSS scores can be reduced, prognosis of patients can be improved, and recovery of patients can be accelerated.