Jean, in my opinion, the documentation will always be what is most important in nursing in the hospital setting. It is all about liability now. At the hospital I worked at, patient satisfaction was most important and a nurse would get called into the office when a patient filled out a form with a complaint, even if this patient ran every nurse into the ground. The manager "had" to call the nurse in. I call this sort of "nurse bashing, getting control of the nurse". And I loved my manager, she was and is a wonderful manager and person but she also is part of the chain ladder up to the CEO. Next, everything was/is about "budget". There is enough in the "budget" for manager meetings, and then meetings about the meetings" but not enough in the budget for patient care. What would help tremendously would be for more aides. Our aides had too many patients and few would get the care they really need. Since the RN is dealing with clicking on the computer, documenting to avoid a legal issue, and seldom has time to do what an aide is trained for, then if we had more aides, patients would be happier, the RN would have time for all those tasks, and a good assessment of the patient but I am afraid, at least where I worked, that this is not in the cards. Don't get my message wrong; I truly loved the job.