Background: Head nurses' managerial skills affect the quality of health care which is reflected on patient's advocacy. The purpose of the study was to assess head nurses' perception to their managerial skills and its relation to their patient advocacy. Design: A descriptive correlational design was utilized. Setting: The study was conducted at Medical and Surgical departments at Benha University Hospital. The study sample is composed of 68 head nurses and their assistants. Instruments: Two instruments were used for data collection (Managerial Skills Questionnaire and patient Advocacy Questionnaire). Results: More than half(51.5%, 55.9%) of study subjects had high perception of conceptual and interpersonal skills as respectively while half of them had moderate perception of leadership and more than two thirds(69.1%) of them had moderate perception of technical skills. More than three quarters (77.9%) of study subjects had positive perception of patient rights while more than two thirds (72.1%) of them had positive perception to their responsibilities for patient's advocacy. Conclusion: There was a highly statistical significant positive correlation between head nurses and their assistants' perception to their total managerial skills and their total patient advocacy. Recommendations:  Hospital management has to develop clear policies regarding patient rights and advocacy. In-service training is needed for head nurses each year to gain technical and leadership skills.