When Florence "just couldn't take it any more," she went to a nurse-managed health center seeking treatment for a urinary tract infection. Although working full-time as a home health aid, 47-year-old Florence did not have health insurance, which is why she tried to ignore her symptoms. Because Florence's problem seemed fairly straightforward, she was prescribed an antibiotic and given instructions to return to the health center if the problem did not improve. Florence's infection was difficult to cure. During countless follow-up visits, she received a diagnosis she was not expecting: diabetes.

Giving patients bad news is never easy. Immediately, communication skills, which we are taught but often forget, come into play. It is important to discuss a patient's problems within the setting of a well-established relationship of acceptance and understanding. When I gave Florence the diagnosis, I sat facing her, with my hand gently on her arm. Looking in her eyes, I said, "Florence, you have diabetes. I understand this is difficult news to hear; however, we'll do everything necessary to help you through this. Your willingness to work with us will get you back to health." Planting a seed of self-care that is so crucial in chronic illness management, I concluded by assuring Florence that I would always tell her the truth and hoped she would do the same. Stunned at the diagnosis, yet resigned, Florence promised to "take care of herself."

Several visits later, Florence clearly was neither taking her medication as prescribed nor was she taking proper care of herself. Despite many teaching sessions, she had not yet gotten the message that diabetes would always need management. Finally, Florence questioned, "Do you mean I'll need that medicine for the rest of my life?"

That realization was the breakthrough we needed, and I explained the pathophysiology of diabetes. Using the simile that insulin was like a key to a lock, I further explained that glucose was locked out of those cells that needed it and could not get in without the key (insulin).

Today, Florence fully engages in her care and is interested in improving her health. Her weight, blood glucose level, and blood pressure are down, and, although not completely cured, her urinary infection is controlled. Furthermore, she now has health insurance through the health center's advocacy activities. More important, Florence understands the importance of being engaged in her own care.

Guiding a patient to this acceptance takes a special set of skills, which are part of the fabric of being a nurse practitioner. Caring and empathetic conversations about health and illness in the context of the totality of the patient's situation are tools to achieving positive outcomes.

Levine and Marek highlight studies that indicate patients engaged in planning their own treatment are healthier and better able to follow the treatment plan.1 Helping patients engage in the self-care process is second nature for nurse practitioners, whose communication practices include sitting down and conveying that they have time, making eye contact, holding intimate conversations, and listening.

Nurses empower patients to live healthier lives. Healthcare encompasses not only diagnosing disease and writing prescriptions but also those conversations between patient and nurse in which the nurse helps the patient realize his or her healthy potential-healthy conversations that are key to excellence in practice.

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