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This study identifies structures, processes, and outcomes associated with hourly nurse rounding.Literature supports that nurse rounding every 1 to 2 hours affects quality outcomes. Evidence is lacking regarding the process of successful implementation.Using an action research design, project leads implementing hourly rounding at 11 Southern California hospitals agreed to recorded telephone interviews. Transcribed interviews underwent content analysis.Analysis revealed 15 major themes. Structure themes include use of rounding behaviors described through an acronym and collaborative phone call. Processes include a library of tools to use incorporating both patient and staff feedback. Patient satisfaction and patient perception of being well cared for are 2 common outcome themes.This study provides evidence that frequent reevaluation of structures and processes promote achievement of desired outcomes in relation to hourly rounding. The authors recommend abandonment of routinization and adoption of flexibility to sustain successful implementation of hourly rounding.