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Role Ambiguity and Role Conflict in Nurse Case Managers: An Integrative Review

Purpose/Objectives: The purpose of this integrative review is to critically examine the relationship between the transition from a direct caregiver to a nurse case manager role and the perceived levels of role ambiguity and role conflict. Primary Practice Setting(s): Nurse case managers in acute care, postacute care, and managed care settings. Findings/Conclusions: Nurses can expect to experience substantial role ambiguity and role conflict as they take on the case manager role, primarily because of inadequate role definition, unexpected ethical challenges, and lack of prior insight into the case manager role. Role ambiguity and role conflict may impact nurse case managers' job satisfaction and job performance. Implications for Case Management Practice: Well-designed broad-scale descriptive studies are needed to further explicate the relationship between transition from direct caregiver to nurse case manager roles and the experience of role ambiguity and role conflict. Nurses transitioning from direct caregiver to nurse case manager roles should be systematically prepared to identify and manage specific ethical challenges commonly encountered by case managers. Further development of a nursing theoretical foundation for case management would be very useful in helping caregivers understand that as case managers, they remain practicing nurses with all the inherent rights and responsibilities of professional nursing.