Background: Metacognition and mindfulness are basic leadership capacities and significant factor in decision making for head nurses. It allows head nurses to be aware of the decision making process, know what factors may influence their decisions, and monitor, regulate, adjust and revise their decisions, even before obtaining feedback. Aim: Assess relation between metacognition, mindfulness and decision making abilities among head nurses. Design: A descriptive correlational design was used. Setting: All medical and surgical units at Benha University Hospital. Subjects: Convenient sample consisted of head nurses (112). Tools of data collection: Three tools were used namely; I) Metacognitive Awareness Inventory. II). Five Facet Mindfulness Questionnaire III) Decision Making Abilities Scale. Result: Clarified that (75.0%) of head nurses had high level of metacognition, (62.5%) of them had high level of mindfulness. And (84.3%) of them had high level of decision making abilities. Metacognition, mindfulness affects decision making abilities positively. Conclusion: Metacognition and mindfulness was positively statistically significant correlate with decision making abilities among head nurses. The study recommended that: Conduct periodic meetings between head nurses and their staff to allow them to express their feelings, seeking opinions, exchange their experiences during different situations and getting feedback and support.