Aim: To describe to what extent registered nurses use Motivational Interviewing (MI) in smoking cessation communication over time at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care. Background: For smokers with COPD the most crucial and evidence-based intervention is smoking cessation. Method and Results: The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. The nurses’ smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity scale, a behavioral coding system that assesses the practitioners’ use of motivational interviewing. Nurses and patients talked for equal amounts of time in one third of the 26 consultations, whilst nurses talked for longer in the remaining two thirds. To capture an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five as the top score. Evocation, collaboration, autonomy-support and empathy averaged between 1.31 and 2.23 whereas direction scored five in all consultations. Of communication behaviors, giving information was the most frequently used, followed by closed questions, MI non–adherent and simple reflections. MI Adherent, open questions and complex reflections occurred rarely. There were no significant individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion: In smoking cessation communication the nurses had low scores on evocation, collaboration, autonomy-support, empathy and high scores on direction. They also supplied large amounts of information, posed closed questions and made simple reflections. Open questions and complex reflections occurred rarely.