© 2020 John Wiley & Sons Ltd Aims: To explore how general practice nurses (GPNs) communicate lifestyle risk reduction with patients presenting for chronic disease consultations. Design: Qualitative content analysis of video observations. Methods: The audio of 14 video-recorded GPN chronic disease management (CDM) consultations were transcribed verbatim. Deductive content analysis was undertaken using the exploring, guiding, and choosing model, an adaptation of steps used in motivational interviewing (MI). Data collection occurred between August 2017 - March 2018. Results: General practice nurses demonstrated relational skills including the use of open-ended questions, content reflections, and affirmations. However, greater use of collaborative agenda setting, double-sided reflections, summarizing patient priorities, and ‘importance and confidence scales’ could enhance discussions about lifestyle risk reduction. Conclusion: Although GPNs were using some MI techniques, there was room for skill development. Enhancing GPNs’ MI skills has the potential to optimize their effectiveness in communicating about lifestyle risk reduction and the reduction of chronic disease. Ongoing professional development in MI skills and lifestyle risk communication needs to be supported by nurses, workplaces, and educational providers. Impact: This study has identified GPNs’ strengths and challenges in relation to lifestyle risk communication. Fostering these skills has the potential to reduce risk of lifestyle attributable chronic disease.