Communication in patient-provider relationships may be the key to promoting positive patient health outcomes, especially for older persons who may have complex health needs. Many nurse practitioners (NPs) serve as primary care providers for the elderly, but communication in their interactions has not been well studied. Research-based evidence of the outcomes of NP /patient interactions may demonstrate that NPs make positive contributions to patient health, thus providing them a strong voice in today's managed care environment. NPs however, must be willing to commit to research participation to document their effectiveness as health care providers. This paper discusses the opportunities and challenges experienced and the outcomes of the research process of a National Institutes of Health/National Institute of Nursing Research funded study of communication between 30 NPs and 150 patients age 65 and older. Videotaped encounters in multiple primary care settings and patient questionnaire completion demonstrated positive patient outcomes from NP care despite considerable challenges faced in NP recruitment, retention and obtaining agency approval.