Objective: To explore the impact of systematic stepwise rehabilitation nursing intervention on the prognosis and disease uncertainty of patients with hypertensive intracerebral hemorrhage, and to provide feasible strategies for clinical nursing. Methods: Eighty patients with hypertensive intracerebral hemorrhage admitted to our hospital from January 2023 to June 2025 were selected and randomly divided into an observation group (n = 40, receiving systematic stepwise rehabilitation nursing) and a control group (n = 40, receiving conventional nursing). The intervention effects were analyzed by comparing changes in the National Institutes of Health Stroke Scale (NIHSS) scores for neurological recovery, Short Form 36 Health Survey (SF-36) scores for quality of life, Exercise of Self-Care Agency Scale (ESCA) scores for self-management ability, compliance, and the Mishel Uncertainty in Illness Scale (MUIS) scores between the two groups. Results: All scores in the observation group were significantly better than those in the control group after the intervention (p < 0.05). Specifically, the NIHSS scores decreased more significantly, the total SF-36 scores increased, the ESCA scores increased significantly, while the MUIS scores decreased significantly, and compliance improved markedly, indicating a reduction in disease uncertainty among patients. Conclusion: Systematic stepwise rehabilitation nursing intervention can significantly improve neurological recovery, quality of life, self-management ability, and compliance in patients with hypertensive intracerebral hemorrhage, while effectively reducing disease uncertainty. It is worthy of clinical promotion and application.