Objective: To explore smoking cessation communication between patients and registered nurses in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care. Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses with a few days of Motivational Interviewing (MI) based education. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity Scale (MITI) and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did only to a small extent evoke patients’ reasons for change, foster collaboration and support patients’ autonomy. Nurses provided a lot of information (42%), asked closed (21%) rather than open (3%) questions and made more simple (14%) than complex (2%) reflections. Patients communication were mainly Follow/Neutral (59%), Reasons for and against smoking 40%, least common were Taking steps (1%) and Commitment (0%) toward smoking cessation. Conclusion: The nurses did not use professional smoking cessation communication and the patients did not talk about how to quit smoking. Practice Implications: To make the patients more active in their smoking cessation process at nurse-led COPD clinics in primary health care the nurses need continuous education and training in smoking cessation communication.