This descriptive, correlational study was designed to explore the relationship between the empathy skills of primary nurses and the distress level of their primary patients. Data on empathy skills were generated from the La Monica Empathy Profile. Data on patient distress were generated from the Profile of Mood State Inventory and a Visual Analogue Scale. A nonprobability convenience sample of 65 primary nurses employed on surgical primary nursing care units of a large teaching hospital participated in the study. Sixty-five cancer patients assigned to the participating primary nurses also took part in the study. Descriptive statistics of each variable were examined. Pearson product-moment correlations were used to examine the hypothesis and the demographic variables for nurses and patients. Analysis of variance was used to assess relationships among many of the demographic variables. A significant correlation (but not in the expected direction) was found between the perceiving/feeling/listening empathy skill and patient distress. Nurses' age, years of experience, and education were significantly correlated with some empathy skills. Distress levels of female patients were higher than those of male patients. In general, nurses scored low in the use of empathy skills, and patients scored low in distress. The complex nature of defining and measuring communication skills and relating these skills to outcomes in patient care, such as distress, requires more study. Research questions exploring how and why nurses' interpersonal skills make a difference to patients and their health care outcomes must be generated by nurse administrators, nurse educators, nurse researchers, and practicing nurses.