Background: Patient satisfaction is a major goal of long term nursing care. Patient satisfaction is a subjective concept and is measured by the patients' perceptions, expectations and previous experiences with hospital personnel or the healthcare organization. It is an important indicator of the quality and efficiency of healthcare systems. Quality of care could be lost if patient expectations are not met. Regular assessment of hemodialysis patient satisfaction with nursing care is effective in increasing the quality of nursing care through identification of defects in nursing practices and implementation of necessary modifications. Objectives: the present study aimed to identify level of patients' satisfaction with nursing care in hemodialysis units. Settings: the study was carried out at the hemodialysis units of The Medical Research Institute Hospital (university hospital), Gamal Abd El Nasser Hospital (health insurance hospital), Sharq El Madina Hospital (governmental hospital) and El Shefaa Hospital (private hospital) in Alexandria, Egypt using a descriptive research design. Subjects: The study included 120 patients (30 from each hospital. Tool: one developed tool was used for data collection: "Hemodialysis patients' satisfaction with nursing care questionnaire sheet". Results: the majority (93.3%) of participants were dissatisfied with all aspects of nursing care at the selected settings. A statistical significant difference was found between the four selected settings about patients' satisfaction with introduced nursing care at hemodialysis units at the favor of private hospital. A statistical significant relation was found between level of education and patients' overall satisfaction with nursing care with p value equal (0.003*) as, 75% of satisfied patients were illiterate while, no patient with university education was satisfied. Conclusion: the majority of participants were dissatisfied with nursing care at hemodialysis units. Recommendation: Nurses should assess and identify the defects in nursing care, and carry out appropriate changes to improve the quality of nursing care and raise the patients' level of satisfaction.