Patients arrive at emergency departments in distress. Physical needs are addressed, but less pressing emotional and social needs often go unrecognized. Although patients may not articulate their concerns, they may later feel dissatisfaction if needs were unmet. This study determined whether emergency department patients and nurses have similar perceptions of patients' needs, and which needs patients identify as most important. A convenience sample of patients and nurses in a two-hospital system was selected. Study results indicate that nurses may not always perceive accurately patients' needs or the strength of those needs. Institutions that place a high value on patient satisfaction with care must treat patient-centeredness as a priority-at all institutional levels.