A qualitative research approach was taken to examine (1) how teachers used running records to identify students’ needs, and (2) how those needs were addressed in subsequent instruction. Participants included three first-grade classroom teachers from across two schools, and one high-, average-, and low-performing reader in each classroom (nine first-grade students in all). Four data sources were collected: (1) brief initial interviews to identify demographic data for teachers and students, (2) video recordings of running record sessions and brief instruction immediately following these sessions, (3) artifacts from the running record sessions, and (4) semi-structured teacher interviews after teachers had time to more deeply analyze the running record assessment data. Data were coded using emergent coding and constant comparative analysis to identify themes and subthemes that reflected how teachers used running records to identify students’ needs and how those needs were addressed in instruction. Findings showed that (1) teachers’ data collection was inconsistent, (2) teachers blurred the line between assessment and instruction by integrating instruction into their assessment, (3) the quality of the in-the-moment analyses of assessment varied across teachers, (4) teachers identified most of their students’ needs when given additional time for analysis, (5) teachers addressed a limited breadth of needs (just chunking and retelling) despite broader student needs being evident, and (6) the quality of instruction was consistently varied. This study extended knowledge in the field about how first-grade classroom teachers use running records for assessment and to guide instruction.