Nurses working in a range of clinical settings may encounter patients who report experiencing hallucinations, whether auditory, visual or any other form. This article, which has been written for nurses working in general practice rather than mental health practice, clarifies the differences between hallucinations and delusions and explains that both symptoms are often experienced together in mental illness. The possible causes of hallucinations are summarised and the advice that should be given to patients is discussed. Although patients might manage their hallucinations by creating narratives to explain what is happening to them and to find ways of representing their experience to others, diagnosis and treatment of underlying conditions are important too. The article outlines precepts that can guide the nurse’s response to a patient presenting with hallucinations for the first time.