A nurse is practicing in a case management context and a patient has been following a multidisciplinary action plan (MAP). In the last 24 hours, it has become clear that the patient's health status is not improving as quickly as expected and the patient is deviating from the MAP. What is the nurse's best action?

When a patient deviates from a multidisciplinary action plan (MAP), the correct and immediate nursing action is to document the deviation as a variance. A variance occurs when a patient does not progress as anticipated within the MAP's timeframe — this can reflect patient, system, or provider factors. Documenting the variance is essential because it creates an accurate clinical record, triggers a review by the interdisciplinary team, and guides necessary modifications to the plan. The MAP itself is not automatically cancelled; instead, it is revised or adjusted based on the documented variance and team input. This process is central to case management and continuous quality improvement. Cancelling the MAP entirely without a team meeting or without documented evidence of need would be premature and disruptive to care coordination. Transferring the patient to a new setting is not indicated simply because a variance has occurred — most variances are resolved through plan modification rather than setting changes. Abandoning standardized care in favor of fully individualized care dismisses the evidence-based value of MAPs and is not warranted at the first sign of deviation. The nurse's priority is to follow the established process: identify the variance, document it accurately, and collaborate with the interprofessional team to address it, preserving continuity and the integrity of the care plan.