When talking about documentation, there is one powerful saying that comes into my mind which I heard a lot of times from my clinical instructors back home – “if it is not in writing, it did not happen”. For me, the message of this expression is about using documentation as evidence. Document in general as defined by American Heritage Dictionary of the English Language (2011) is a written or printed paper and can also be recording or photograph that bears the original, official, or legal form of something that can be used to furnish decisive evidence of information. As nurses, we deal with lots of legal matters since we are handling lives. Our documentation will save us from litigation. If we cannot present evidence of an event or activity then everything we say will just be speculations, which are not accepted in the court. I believe this is the most important reason why we need to document.

In nursing practice, College of Nurses of Ontario (CNO) states that “documentation—whether paper, electronic, audio or visual—is used to monitor a client’s progress and communicate with other care providers. It also reflects the nursing care that is provided to a client.” (2008, pg. 3) Personally, I could not imagine caring for patients without documenting the assessment, the interventions or implementations, the patient’s response to the care provided and other necessary information. I will not be able to memorize what was done in the whole shift and endorse the care I provided to ten patients to another nurse or to other health care providers for collaborative treatment. Without documentation, we cannot guarantee the continuity of care. Another importance of nursing documentation according to CNO (2008) is it “demonstrates the nurse’s commitment to providing safe, effective and ethical care by showing accountability for professional practice and the care the client