Which action should the nurse implement first when a desired outcome is not achieved in a care plan?

• A. Establish a new nursing diagnosis.
• B. Note which actions were not implemented.
• C. Add additional nursing orders to the plan.
• D. Collaborate with the healthcare provider to make changes.

Answer: (B)

When a desired outcome isn’t reached, the first priority is to determine what parts of the plan were actually carried out. Noting which actions were not implemented clarifies whether the lack of progress stems from incomplete execution or from the plan itself needing modification. This step creates a clear record, guides the next steps, and prevents unnecessary changes before understanding what happened. Once you know what wasn’t done, you can decide whether to reinforce or adjust the current interventions, or proceed to collaborate with the provider to modify the plan if needed. If all actions were implemented and the outcome is still not achieved, that’s when more substantive changes to the plan or new orders would be considered.