A divergence exists between registered nurses? (RNs?) intention to document together with the patient and their actual documentation practice; a practice that also diverges from official intentions of patient participation. This study aimed to explore and describe RNs? reflected experiences on patient participation in nursing documentation. A descriptive qualitative study was conducted based on three focus groups with 14 registered nurses from an acute medical ward. Content analysis and conversational analysis were performed. The reporting adhered to the COREQ checklist. The findings showed that nurses made little mention of patient participation in nursing documentation due to challenges in meeting both the patients? expected needs and nurses? needs. However, patient participation was important for time accurate and summative nursing documentation. This study adds to a critical debate on patient participation and contributes to a practice-based understanding of the challenges that registered nurses experience concerning patient participation in nursing documentation.