This study investigates nurse–patient communication in the cancer care context. Interviews with nurses and patients about their communication experiences and audio-recorded nurse–patient conversations were collected and analysed. A theme of ‘optimism’ largely manifesting as ‘constructive realism’ was one of four features identified by the qualitative analysis. The health professional has traditionally been viewed as the party with the power and control over conversation progression and topics. In particular, the superficial, positive and chatty nature of nurse–patient interaction has often been attributed to a lack of nurses' communication skills training. This research indicates that both patient and nurse are active in its construction and argues that the optimistic cheerful nature of nurse–patient interaction may be better viewed as a jointly produced institutional feature of cancer care. This paper illustrates and examines some of the ways this outcome was created and maintained by participants and discusses the implications of this.