Nurse-patient interactions were examined to identify elements of interpersonal competence among nurses from the perspective of patients. Forty patients and 12 nurses participated in this qualitative study at a private acute care hospital. Two-hundred and forty-five observations were completed. Open-ended questions were utilized in 85 audio-taped semi-structured interviews. Data collection and analysis occurred simultaneously using the constant comparative method. Four major processes emerged from the data to provide the framework for the themes: 'translating', 'getting to know you', 'establishing trust', and 'going the extra mile'. In the 'translating' theme, patients expressed satisfaction with the nurse-patient interaction when nurses informed, explained and instructed on specific aspects of treatment, and taught general principles of care. The nurses' personal sharing, kidding and clicking appeared as important processes in 'getting to know you'. Patients reported confidence and trust when nurses took charge and appeared to enjoy their work. The theme of 'going the extra mile' included friendship and providing care beyond that expected. The processes provide a framework for an emerging theory of interpersonal competence.