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Hemodialysis now is an important and standardized treatment that is used as a life-saving treatment for more than 800,000 people worldwide who have end-stage renal disease. Protecting patients from adverse events at hemodialysis units is fundamental responsibility of all health team generally and nursing especially. Aim: To evaluate the effect of nursing instructions on nurses' knowledge, practice and suggestions regarding adverse events in hemodialysis. Research design: A quasi experimental design was utilized. Setting: The study was conducted in hemodialysis unit at King Khalid Hospital in Hail City; Kingdom of Saudi Arabia. Sample: Convenient sample of 26 nurses working in hemodialysis unit. Tools: First; Self-administered nurses' knowledge questionnaire; Second; Safety and quality observational checklist in hemodialysis session. Results: There was a statistical significant improvement between levels of nurses' knowledge and practice before and after nursing instructions, no relation between levels of nurses' knowledge and their levels of practice post nursing instructions and there was a difference in nurses' suggestion ranks regarding adverse events prevention pre and post nursing instructions. Conclusion: Implementation of nursing instructions regarding adverse events in hemodialysis was effective in improving the level of nursing knowledge and practice. Recommendations: Applying nursing instructions in other places with a large sample to enhance and confirm the current results.