Problem & Purpose: In a small psychiatric hospital, nursing leadership is concerned about the inconsistent, disjointed nursing shift report process that contributed to shift reports that are often lacking important information. Poor communication of important patient information contributes to adverse patient safety events, which impacts patient outcomes. The purpose of this quality improvement initiative was to implement a structured handoff format, ISBAR framework, to be used during verbal nursing shift report, as well as a similarly structured format to be used for nursing shift note documentation in the electronic health record. Methods: Nurses were trained to use the structured handoff format for both verbal nursing shift report and for documenting nursing shift notes. The training was assigned to 49 total nurses. Posters outlining the information to be detailed under each category within the ISBAR framework, and written templates, were made available in each nurse work area. Weekly audits using convenience sampling were completed to determine the percentage verbal shift reports and written shift notes that followed the structured handoff format with 100% compliance. Results: Nurse buy-in and uptake of the structured handoff format was minimal. Rate of 100% compliance with the structured handoff format for both shift report and shift notes was 0% for the first 4 weeks of implementation. The highest utilization for shift report was 40% in Week 6, after which utilization trended downward for the remaining 8 weeks, with rate of compliance returning to 0% in the last week. Utilization for shift notes trended upward over the course of the initiative, with a peak compliance rate of 52% in Week 13. Conclusions: The impact of strongly ingrained cultural norms cannot be underestimated when undertaking a quality improvement initiative at any institution, and efforts beyond nurse training and making resources available must be used to incentivize uptake of any process change.