Since the study depended on the clinician documentation, some activities that occurred may not have been recorded. Nurses work a variety of shifts to provide adequate patient care; 24-hour staffing can consist of 4-, 8-, and 12-hour shifts in combinations that vary from day to day. Thus, it is difficult to know how often nurses were compliant in documenting project-specific information into their PDAs or supplemental electronic documentation. Education that was initiated by nurses on one shift and completed by nurses on the following shift may not have been documented in its entirety if the initiating nurse did not document her time. If nursing leaders varied in how much they stressed the importance of completing supplemental documentation, nursing staff may have had differing levels of understanding of its importance. However, with over 42 000 shifts included in the SCIRehab database, we believe that we captured a sufficient picture of care provided to determine the amount and variation of time spent on care management and educational topics. Additionally, education activities that take less than 10 minutes may be meaningful but would have been not captured and, thus, not reflected in our findings.