Objective: This article explores the training and counselling experiences of 20 nurses, aiming to identify key elements in the process of learning and applying motivational interviewing (MI) counselling skills with adherence to protocols. Setting/method: The nurses were recruited from 10 primary health care units in Östergötland, Sweden. The study was carried out after the nurses had been practicing MI counselling in daily clinical work for about a year. Data were collected by means of semi-structured interviews, based on an interview guide, which contained questions on factors that past research has identified as important for effective training in and practicing of MI. Results: The interviews revealed several key factors for successfully learning and applying MI. Extensive training and close integration of training and practice were seen as crucial aspects to effective learning of MI skills. A barrier to satisfactory learning of the MI counselling skills was the difficulty of adjusting to the new way of thinking required when practicing this technique, since it contrasted with the authoritarian expert approach that the nurses were used to. Another difficulty was achieving effective communication with patients who were unwilling to accept responsibility for their own health. Conclusion: Effective learning and application of MI skills with adherence to protocols is fraught with many problems, requiring a considerable amount of time and effort for practice as well as the adoption of a new frame of mind with regard to the health care providers' relationships with the patients. © SAGE 2008.