Effective strategies for reducing the most common occupational injury among nurses, needle punctures, were evaluated. To develop a successful program for reducing needle puncture injuries, nurses' perceptions of causes and solutions to this problem were surveyed. Participating in the study were 93 urban hospital nurses, 92 percent of which were female and 80 percent of which were under the age of 25. Educationally, 59 percent had bachelor's degrees, 15 percent had associate degrees, and 26 percent had diplomas. Randomly distributed to the nurses were eight written descriptions of needle injuries, each differing in three aspects: positive or negative characteristic of the nurse; positive or negative hospital environment conditions; or mild or severe injury. For each described injury, nurses evaluated liableness of the nurse, relative importance of personal and environmental factors, and whether the injured nurse could have avoided the injury. Additionally, participants rated effectiveness of five personal and five environmental oriented strategies for reducing needle injuries. In each instance, surveyed nurses judged personal factors as the major cause of injury. Nurses with negative characteristics were deemed more responsible for the needle injury than nurses with positive characteristics; nurses working under negative hospital conditions were thought to be less responsible for the injury. Environmental solutions were considered more effective in reducing needle injuries than personal solutions. According to the nurses, the most effective solution involved frequent inspections of needle disposal units and frequent emptying of units. A second study in another hospital yielded similar results for perceptions of causes and solutions. The author concludes that hospital nurses feel that environmental workplace changes are needed to reduce the number of occupational injuries among nurses.