Communication is a central part of nursing practice. The importance of good communication in the delivery of effective and appropriate nursing care has been well demonstrated by research and is reflected in policy documents. However, despite the emphasis on teaching communication skills over the past two decades, good communication is often curtailed by structural factors. These include the nature of ward organisation, remote management styles, and an overwhelming emphasis on increased patient throughput. Increased day surgery together with the greater use of bank and agency staff place further limits on nurses' ability to develop a substantial rapport with patients. It is concluded that adequate time and support are needed to enable nurses to communicate therapeutically with patients in order to achieve care that is effective and responsive to their needs.