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In some areas, A focus on skill mix has led to the replacement of professional nurses with health care assistants who might have minimal training.4 This possible schooling would include biology fewer trained staff and more intensive interventions raises concerns about whether, In a context of constrained expenditures, the standard of care will deteriorate as a result.More than about ten years ago, Two landmark reports the World Health company The world health report 20005 and the Institute of Medicine's Crossing the quality chasm6 called for the realignment of incentives to balance the often competing goals of cost containment and quality improvement. Both reports figured responsiveness to citizens' expectations was a valued and desired outcome of health system performance. Efforts to measure patient satisfaction have thus extra,7 and in some countries around the world, benefits have been adopted to foster patient satisfaction and patient centred care.8 9Research confirms that features of the hospital work environment (Such as better staffing ratios of those to nurses, Nurse involvement in decision making, And positive doctor nurse operations) Are linked to improved patient outcomes, Including fatality rate and patient satisfaction.9 10 11 12 13 This association is probably due to the important role of nurses in the surveillance system of hospitals.