Intravenous thrombolysis and acute neurointerventional therapies such as or neurothrombectomy / aspiration should be compleed by two approaches in order to achieve meaningful success in acute stroke clinical practice. The first is the “acute stroke system of care” that will ensure the timely and safe transfer and triage of acute patients to the centers, and the second is the management of these patients in the hospital stay during the acute period. In-hospital acute stroke practice is a comprehensive process that begins in neurological intensive care or stroke units, and the results are directly affected by the level and quality of stroke nursing practice. Acute stroke nursing consists of, but not limited to, effective and safe application of stroke-specific treatments; management of blood pressure, blood sugar, swallowing, nutrition and hydration; patient's posture, mobilization, early physical therapy and rehabilitation plan; monitoring of consciousness and neurological examination; venous thromboembolism, gastric ulcer and infection prophylaxis; prevention of complications such as KIBAS, infection, respiratory failure and bleeding and intensive care unit management and very effective patient, patient relative and team interaction and communication. This manuscript presents the fundamental practices and metrics adapted for our country from many current guidelines of acute stroke nursing.