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Miscommunication is a major factor in most medical errors. Conventional change of shift report is particularly vulnerable to communication errors. Shift-to-shift nurse/patient handoff report has traditionally occurred at the nurses’ station, not in the presence of the patient. Traditional patient hand offs eliminates patient input. It also dismisses opportunity for the on-coming nurse to visually assess the patient along with the off-going nurse. It reduces the opportunity for the presence of two nurses to verify medications and patient identity. The ultimate goal of this project is to improve the communication between nurses and between nurses and their patients.           Nurse to nurse bedside report provides opportunity to communicate and reinforce the plan of care to the patient. This information is now transferred in the presence of the patient. The patient can become a layer of safety in their care by facilitating patient involvement. It improves the amount of time nurses spend at the patient’s bedside. Taking a task done away from the bedside and bringing it to the patient improves the amount of direct nurse/patient interaction. This has been found to be highly related to improved patient satisfaction.  The on-coming and the off-going nurse assess the patient together. This provides support for nurses to learn and educate one another. The work environment for the nurses is enhanced because it eliminates the “blame game” between shifts and supports teamwork, teaching and learning among the nursing staff. Research shows patients have a better perception of nursing with the use of Nurse to Nurse Bedside Report. Patients are able to witness nursing care that was once not visible to them. On-coming nurses can ask questions they may have only from their visual assessment of the patients and they are able to see their patients at the very beginning of the shift. This process provides reassurance to the patient by witnessing their concerns and preferences communicated to their new nurse. This provides safer care and supports a patient centered approach to nursing care.            The rationale for implementing Nurse to Nurse Bedside Report was based on the evidence gleaned from a literature review. Staff was educated on the need for change. Guidelines were established using staff input. This process began in November 2007. Implementing a culture change is a difficult and time-consuming task. In order to measure the benefits of this new process had we had to first make sure the nurses were accepting the change. Measuring staff acceptance was done by measuring the use of Nurse to Nurse Bedside Report with each patient handoff. This paper will describe the strategies used to put this process into practice and how we overcame obstacles in successful implementation.