While the body of nursing research in forensic psychiatry is growing rapidly, the therapeutic nurse–patient relationship in secure hospitals needs to be further examined. This paper reports on a research project that found two representations of the nurse–patient relationship in two male acute secure inpatient units. One representation was formed by the data collected from the unit nurses in semistructured interviews. The nurses valued the relationship and described their practice as therapeutic, however, evidence from the interviews would suggest that the nurses operate from a social frame of reference. Examination of the nurses ‘entries in patients’ case files formed the other representation. Through their documentation practices, nursing was represented as being oriented to custodial care. While neither representation can capture the clinical reality, these findings are relevant to forensic psychiatric nurses as their entries are a historical record through which their practice will become known to others, and in some cases, judged by others.