To investigate potential barriers and enablers prior to the implementation of the Tell-us card. Patient participation has the potential to improve quality of care and has a positive effect on health outcomes. To enhance participation of patients, adequate communication between patients, their relatives and healthcare professionals is vital. Communication is considered as a fundament of care according to the Fundamentals of Care Framework. A strategy to improve patient participation is the use of the Tell-us card; a communication tool that patients and relatives can use during hospitalisation to point out what is important for them during their admission and before discharge. Investigating barriers and enablers is needed before implementation. A qualitative study. Semistructured, individual interviews with (head)nurses, nurse assistants and midwifes. Interviews were audio-recorded, transcribed and analysed using the framework analysis method. The COREQ checklist has been used. The need to maintain control over care, reluctance to engage in in-depth conversations, fear of being seen as unprofessional by patients, fear of repercussions from physicians, the lack of insight in the meaning of patient participation and the lack of appreciation of the importance of patient participation appeared to be majors barriers. Participants also elaborated on several prerequisites for successful implementation and regarded the cooperation of the multidisciplinary team as an essential enabler. The identified barriers and enablers revealed that nurses and midwives are rather reluctant towards patient participation and actively facilitating that by using the Tell-us card communication tool. A number of issues will have to be factored into the implementation plan of the communication tool. Tailored implementation strategies will be crucial to overcome barriers and to accomplish a successful and sustainable implementation of the Tell-us card. © 2019 John Wiley & Sons Ltd.