Mental imagery strategy is an effective educational tool to enhance skill performance especially where real practice is limited. Aim of the study: Was to determine the effect of implementing mental imagery strategy on nursing students, performance, satisfaction and self-confidence regarding neonatal endotracheal suction procedure. Quasi experimental research design was used. Subjects and Method: Eighty pediatric nursing students at the third year, Faculty of Nursing, Tanta University. Four Tools: Were used to collect data: Students knowledge regarding endotracheal suctioning, betts' questionnaire mental imagery vividness of mental imagery scale, student satisfaction and self-confidence in learning scale and airway suctioning observational checklist. Results: Revealed that the total scores of students' knowledge and practice for majority of study and control groups were unsatisfactory before teaching interventions and improved for both groups immediately and 2weeks after teaching intervention with higher scores for study than control group. Conclusion:It can be concluded that students studied with mental imagery strategy showed a significant improvement on knowledge, practice, satisfaction and self-confidence in relation to endotracheal suctioning than students studied with traditional learning method. Recommendation: Clinical nursing education programs should integrate mental imagery strategy in parallel with physical practice for the curriculum development to enhance skill performance.