On almost any scale, in the real world of nursing practice, traditional care plans usually come up short. They offer little of the simplicity and flexibility nurses require in treating patients as individuals. They also don't make problem solving, or essential communication between caregivers, any easier. At our hospital, nurses have devised a new approach to planning patient care. It isn't static and doesn't resemble a homework assignment. Instead, it's a dynamic way of meeting both patient and nursing needs. Circumventing the weaknesses of most traditional care plans was our goal. We recognized that predeveloped care plans based on medical diagnoses, for example, can be excellent resources, but when a patient has more than one medical diagnosis, nurses must then combine several lengthy and often redundant, or even contradictory, predeveloped plans into one working system. On the other hand, individualized care plans are time-consuming to maintain. Frequently, entries lapse and the plan is allowed to become obsolete. Updating takes so much time that it can be done only when there is a lull. So, in effect, the care plan becomes a clerical formality, ignored when the nurse is charting in the clinical record or reporting to the oncoming shift. Neither has the traditional Kardex been an especially useful format for care plans. The Kardex provides a shopping list of things to do-often medically directed interventions. Instead of promoting problem solving, its task-oriented approach reinforces the dependent dimensions of nursing practice. Even the insertion of a blank care plan space on the Kardex doesn't solve the problem, because the nurse must still find the time needed to draw up an individualized care plan. The nurses in our coronary care unit, and a committee of staff nurses reviewing the care plan documentation, asked a number of pointed questions about the system we were using. 0 Why, they wondered, write interventions on the care plan if they are already listed on the Kardex?