Background: Because entrepreneurial leadership is a unique type of leadership, head nurses believe in it in making effective decision The present study aimed to explore head nurses' perception of entrepreneurial leadership and its relation to decision making effectiveness. Subjects and Method: Design: Descriptive- correlational research design was used. Setting: The study was conducted at Tanta Main University Hospitals, and El-Mnshawy General Hospital, and Qotour general hospital which affiliated Ministry of Health in El-Gharbia Governorate. Subjects: Study subject was included 189 head nurses working at the abovementioned setting. Tools: Data were collected by using two tools:1- Head nurses' perception of entrepreneurial leadership questionnaire. 2- Head nurses' decision-making effectiveness scale. Results: As total, more than fifty (52.9% and 55.0%) of head nurses had high and moderate perception level of entrepreneurial leadership and decision-making effectiveness. Conclusion: There was significant positive correlation between head nurses ' overall perception of entrepreneurial leadership and its subscales, and their overall their decision-making effect and its dimensions. It was recommended that top management need to encourage head nurses to demonstrate entrepreneurial leadership to create a healthy work environment and culture that promotes effective decision making.