A 21-item observation tool developed by one of the authors was used to assess learning needs of 30 registered nurses who regularly suction intubated patients. Of the nurses observed, 97 percent had excellent regard for proper equipment utilization and 91 percent for maintenance of sterile environment. These high percentages were responsible for pulling the overall average score to 65 percent, thus partially disguising the acute need for patient assessment (38 percent), psychological support (57 percent), and procedure (62 percent). Scores for subgroups of nurses–associate degree (group I), diploma (group II), and baccalaureate (group III)—were 72, 69, and 65, respectively. Of particular concern were low scores in the assessment and psychological support categories. Despite increased emphasis on both of these areas in nursing programs in the last decade. AD graduates received scores of 52 and 57 percent while diploma graduates received scores of 38 and 58 percent and baccalaureate graduates received scores of 26 and 55 percent.