Background: In 2001, the newly established Regional Health and Welfare System of Crete commissioned the first needs' assessment study of nursing personnel employed in the public sector of primary health care (PHC). Aim: To capture the profile and professional needs of nursing staff working in Health Centers throughout the island of Crete and explore variations in nursing practice by educational preparation. Methods: A newly developed, psychometrically tested questionnaire, was administered to all nursing staff in 14 rural Health Centers. Findings: Vacancy rates are high, indicating a serious staffing deficit. The type of degree earned (2-year vs. 3 or 4-year program) does not differentiate nursing practice, with only two exceptions (obtaining a patient's history and counselling patients). The majority of respondents assess their existing knowledge and skills as 'adequate' while indicating a strong desire for continuing education. Job satisfaction is high in terms of interactions with clients and community recognition, while it is rated 'low' in terms of daily interactions with colleagues and support from work environment. Conclusion: Cretan nursing staff in PHC operate within a restricted and task-orientated framework. Their educational preparation has little effect in practice role variations and professional needs. The Regional Health and Welfare System of Crete should address daily supervision and support issues, on-the-job training, continuing education needs, while taking immediate action to avoid potential turnover of existing staff and to aggressively recruit young, qualified nursing staff who will choose a career in PHC nursing. © 2006 International Council of Nurses.