OBJECTIVES: To quantify the incidence and risk of needlestick injury (NI) in nurses caring for patients with diabetes. METHODS: Four hundred nurses caring for patients with diabetes in 381 hospitals throughout the United States reported data on their experience with NI, focusing on those occurring within the past year. If respondents experienced multiple NI during this period, detailed data were collected on the most recent event. RESULTS: Of the 400 nurses, 313 (78.3%) reported having ever had a NI, 110 (27.5%) reported having had a NI within the last twelve months, and 44 (40% of those 110) reported multiple NI. Nearly two-thirds of these injuries (n=73; 66.4%) were punctures that drew blood, resulting in one case of contracted hepatitis C. The cumulative annual incidence of NI events was 448 NI per 1000 nurses. Nurses reported the injury in adherence with existing policies in 21.8% of cases. Disposable syringes were involved in 88 (80%) of the events. In half of the injuries (n=55), the needled device was equipped with a safety feature that was ineffective, primarily because it was not fully activated (n=47; 85.5%) or it malfunctioned (n=2 to 5; 3.6% to 9.1%). NI most commonly occurred while nurses were injecting insulin (n=33; 30%). In the two weeks following their NI, 60.1% of nurses were more afraid of needled devices than before the injury and 41.8% felt anxious, depressed, or stressed. As a direct result of the NI, nurses missed 77 days of work. CONCLUSION: This study is the first to show the relatively high risk both of NI and of NI that draws blood among nurses injecting insulin with a disposable syringe. Additionally, this study reveals significant post-NI emotional distress, suggests significant under-reporting of NI to hospital officials, and demonstrates the need for a more effective needle safety device.