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Aims and objectives To explore: i) the frequency and nature of patient participation in nursing handover and ii) patients’ and nurses’ perceived strategies to enhance patient involvement in nursing handover. Background Patient participation in nursing handover is important for patient‐centred care, shared decision‐making, patient safety and a positive healthcare experience Design A multi‐site prospective study using a mixed methods design. Methods Between September and December 2019, nursing handovers were observed on ten randomly selected wards, followed by semi‐structured interviews with patients (n = 33), and nurses (n = 20) from the observed handovers. Data were analysed using descriptive statistics for structured observations and thematic analysis of interviews, and triangulated to develop a greater understanding of patient participation in nursing handover. This study is reported using the Good Reporting of Mixed Methods Study guidelines. Results The median patient age was 77 years and 47% (n = 55) patients were female. Of the 117 handovers, 76.9% (n = 90) were conducted in the patient's presence. Patients were active participants in 33.3% (n = 30) and passive participants in 46.7% (n = 42) of handovers; in 20% of handovers (n = 18), the patient had no input at all. Active participation was more likely in women (vs. men), surgical patients (vs. medical patients) and when nurses displayed engagement behaviours (eye contact, opportunity to ask questions, explanations). Three major themes were identified from the interviews: ‘Being Involved’, ‘Layers of Influence’ and ‘Information Exchange’. Conclusions The main finding was that patient participation in handover was low and strongly influenced by a complex interplay of factors including patient and nurse preferences and perceptions. Relevance to Clinical Practice Handover is an essential tool in the provision of safe patient care. Patients were able to actively participate in nursing handover when they understood the purpose and timing of handover and had rapport with nurses.