Objective—To get nurses and assistants' perspectives on why patients in acute care hospitals fall. Background—Despite the abundance of quantitative evidence to guide the assessment of fall risk and the absence of high-tech, rare, or expensive equipment to prevent falls, falls remain a serious problem in hospital. Methods— Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for the analysis. Outcomes—Positive and negative components of 6 concepts—patient reporting, access to information, signage, environment, teamwork, and patient/family involvement—form 2 main categories: knowledge/communication and skills/actions that respectively facilitate or hinder fall prevention. Conclusion—Two conditions are required to reduce patient falls. A patient care plan that includes current and accurate fall risk status with relevant and achievable interventions should be agreed upon by all stakeholders (whole care team). health, patients and families) easily and immediately. Second, stakeholders should use this information, along with their own knowledge and skills, and patient and hospital resources, to implement the plan.