Much research has examined the nature and duration of nurse-patient communication. However, few studies sufficiently acknowledge the extent to which communication is influenced by the meanings and perceptions of those involved or the social context in which it occurs. This paper reports on a study which used in-depth interviews with 21 nurses in two accident and emergency departments to explore how their perceptions of their work and patients influenced communication and the way in which patients' anxieties were addressed. A grounded theory approach was used to guide the process of data collection and analysis, and interpretation of findings discussed with reference to a symbolic interactionist perspective. The core category was identified as 'Defining the role of the accident and emergency department nurse'. This category illuminates the nurses' perception of their role and purpose as being primarily concerned with dealing with emergencies and providing urgent physical care. Two other categories, 'Nurses' priorities and patients' anxieties' and 'Keeping the department running smoothly', delineate the impact this view had on the organization and delivery of nursing care in accident and emergency departments and its effect on nurse-patient communication.