Musculoskeletal injury is common among nurses as a result of lifting and handling patients. In response to musculoskeletal injuries, safe patient-handling programs are being instituted to decrease the risk of injuries and resulting impaired function. This study was designed to identify patient-handling practices in clinical practice. This qualitative study used 128 hours of observations of patient-handling practices and interviews of 32 nursing staff who discussed these practices. Findings demonstrated five factors impact nurses' judgment regarding the best way to move patients: complexity of everyday care, patient treatment goals, time, knowledge, and equipment issues.