$$\rightleftharpoonup{xx}$$
$$\longleftharp{xx}$$,
$$\longrightharp{xx}$$,
Dysphagia after stroke increases the risk of aspiration pneumonia, malnutrition, and prolonged hospitalization. Standardized nursing pathways may improve care delivery, but real-world evidence remains limited. This retrospective cohort study, reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, included 210 adult stroke patients with dysphagia treated at Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, from January 2020 to May 2025. Patients received either clinical pathway-based rehabilitation nursing (n = 106) or conventional care (n = 104). Primary outcomes were improvement in swallowing function at discharge and aspiration pneumonia. Secondary outcomes included nutritional status, functional recovery, ICU stay, overall complications, and length of hospital stay. Group differences were assessed using chi-square tests, independent-samples t tests, or Mann–Whitney U tests, and multivariable logistic regression was used to identify independent factors associated with swallowing improvement. Compared with conventional care, pathway-based care was associated with a higher rate of swallowing improvement (72.6% vs. 51.9%, P < 0.001), a lower incidence of aspiration pneumonia (7.5% vs. 15.4%, P = 0.015), higher functional recovery at discharge (Barthel Index ≥70: 68.9% vs. 49.0%, P < 0.001), a shorter ICU stay (1.7 ± 1.0 vs. 2.5 ± 1.2 days, P = 0.002), a lower overall complication rate (21.7% vs. 31.7%, P = 0.029), and a shorter hospital stay (35.7 ± 7.8 vs. 47.9 ± 10.1 days, P < 0.001). In multivariable analysis, clinical pathway-based nursing remained independently associated with swallowing recovery (adjusted OR = 2.12, 95% CI, 1.38–3.27; P < 0.001). Clinical pathway-based rehabilitation nursing was associated with improved swallowing outcomes and fewer in-hospital complications in this retrospective cohort, supporting further prospective multicenter evaluation and integration into standardized stroke rehabilitation practice.