Background: Decisions play important roles as they determine both organizational and managerial activities. It is the key part of head nurses' activities. Decisions are made at every level of nursing management to ensure that the nursing department goals are achieved. Objectives: The study aimed to assess the decision making performance process among head nurses. Methods: The study was conducted at El-Menshawi and El-Mahala General Hospitals which are affiliated to the Ministry of Health and Population. Study subject included all (95) head nurses working at the assigned hospitals. Decision Making Analysis of Areas and Activities Questionnaire and Decision Making Rating Scale for head nurses were used as tools for data collection. Results: More than one third of head nurses propose the budget of nursing department imposed on them and make decision in concerning the needed qualifications of nursing personnel on each unit in conjunction with the chief. Seventy percentages of head nurses at El-Mahala General Hospital had high levels in the decision making process. More than half at El-Mahala hospital had moderate levels in the strategy of decision making performance process. Conclusion: head nurses fulfilled the areas and activities of decision making process but a lot of decisions making is done with the chief either with or without subordinating opinions. Establishing training programs is recommended to help head nurses and subordinate staff in making effective decision, developing the budget of nursing unit and improving standard of care activities.