Running Head: MALPRACTICE DUE TO ROLE CONFLICT

Malpractice due to Role Conflict Among Nurse Case Managers

Jocelyn Iraheta

School of Nursing, James Madison University

Professor Garman

NURS 462: Issues in Contemporary Nursing Practice

Running Head: MALPRACTICE DUE TO ROLE CONFLICT

Malpractice due to Role Conflict among Nurse Case Managers

Within the nursing profession, nurses have the flexibility, skill set and ability to be able

to fill a multitude of positions beyond the bedside. Nurse Case Managers hold a distinct stance

where they broadly focus on the coordination of care, prevention and treatment of clients and

patients through the development, implementation and evaluation of care plans and allocation of

services typically in the setting of public health, workers compensation and hospital

management. It is a role that holds a significant amount of autonomy and independent decision

making. Role conflict occurs when lines become blurred and can contradict roles that people can

play in their everyday and personal life ((Eli-Pierce, 2019). With the increase of responsibility

and inability to distinguish personal versus professional roles, nurse case managers face a higher

risk of liability through malpractice. This specific field of nurses face an increased risk to legal

issues due to the broad description of the role of their position and puts into question their scope

of practice and expectations on a day-to-day basis (Gray & White, 2021).

Background

As discussed by Maher & Cweik (2022), nurse malpractice claims may be submitted for

a multitude of reasons to include failure to perform an appropriate physical examination on a

patient and failure to inform a medical doctor or higher-level provider about an unprecedented

finding about a patient leading to harm. The act of pursuing a malpractice claim against nurses

due to unintentional harm has caused nurses to lose their licensure, face criminal charges and

potentially face imprisonment. Although nurse case managers are registered nurses (RN) in their

state of licensure, it is difficult to distinguish their roles against other forms of nursing and makes

them more vulnerable to facing malpractice charges. There is no set definition or function of a

nurse case manager among various literature as found by Gray & Ann (2021). However, Ely-
Running Head: MALPRACTICE DUE TO ROLE CONFLICT

Pierce (2019) further details how nurse case managers are seen in the field as “specialists” and

therefore, are automatically held to a higher standard than a generalist nurse would have. The

issue with this topic is the inability to distinguish boundaries and roles for the nurse case

manager leading to autonomous decision making without the knowledge of what can or cannot

be done.

Student Perspective

As a BSN student who also works directly within the field of nurse case management in

both a public health and workers compensation setting, I can provide an internal perspective of

the unclear duties of a nurse case manager. Nurse case managers can be employed in several

settings to provide care coordination, but due to the broad role, I can see how it has the potential

to lead to malpractice suits and legal issues. For example, in my role as a workers compensation

case manager, nurses have upwards to 30 cases at a time for anything from smaller injuries to

catastrophic cases. Nursing is a field heavily based on documenting accurately, especially among

nurse case managers. Should a nurse case manager forget or delay treatment, it is more likely

that they face consequences due to role confusion and conflict (Smith, 2021).

According to Ely-Pierce (2019), it is imperative for nurse case managers to understand

the specifics of the complex guidelines associated with federal regulatory and insurance laws.

Even if an action is done within reasonable regard and good faith, it is imperative for nurse case

managers to practice within their scope and have a clear job description. Although malpractice,

negligence, civil and criminal regulations are a discussion in nursing school, it is not common

practice among insurance companies or other entities that hire nurse case managers to educate

their nurses about state and national laws. As a result, nurse case managers are expected to

provide their own research on their specific roles to become well versed in their expectations.
Running Head: MALPRACTICE DUE TO ROLE CONFLICT

Recommendations for Improvement

As a result, recommendations for improving and distinguishing the nurse case manager

role would include providing a conceptual idea of the role of a nurse case manager, specific skill

set and training that a nurse case manager must meet, and ultimately provide clarity in the

expectations of a case manager. By focusing on the elimination of role confusion and conflict,

nurse case managers would be more likely to work within their scope of practice and avoid legal

issues to involve malpractice. In addition, by providing training when onboarding nurse case

managers could help these nurses familiarize themselves with laws and regulations that affect

their nursing practice. The expectation of a nurse case manager is dependent on the population in

which they care for. By setting this expectation, all nurse case managers within that population

would be able to practice without overstepping boundaries and ultimately, preventing liability

issues.

Conclusion

Nurse case managers face a unique circumstance where their position embodies a great

deal of both autonomy and independence in decision making. With the increased responsibilities,

they also face a higher risk of malpractice suits and other legal issues. One of the main issues

with the nurse case management field is the indefinite and broad role of the position placing

them at an even higher risk for facing malpractice due to the inability to determine what they can

or cannot do within their professional role. From a student perspective, it would be important to

create a set and distinct role and clarify expectations and boundaries of a nurse case manager. In

addition, there should be more availability to trainings and onboardings in relation to state and

national laws and regulations that affect these types of nurses. By focusing on this issue of role
Running Head: MALPRACTICE DUE TO ROLE CONFLICT

conflict, nurse case managers would be more likely to practice within their scope and avoid legal

issues such as malpractice.

Running Head: MALPRACTICE DUE TO ROLE CONFLICT

References

Ely-Pierce, K. (2019). Legal issues for case managers: what you don’t know can hurt you.

Family and Community Health, 22(3), 78-91. https://www.jstor.org/stable/44938086

Gray, F. C., & White, A. (2021). Concept analysis: case Management role confusion. Nursing

Forum, 47(1), 3–8. https://doi.org/10.1111/j.1744-6198.2011.00244.x

Maher, V., & Cwiek, M. (2022). Criminal liability for nursing and medical harm. Hospital

Topics, 1–8. https://doi.org/10.1080/00185868.2022.2101571

Smith, A. C. (2021). Role ambiguity and role conflict in nurse case managers. Professional Case

Management, 16(4), 182–196. https://doi.org/10.1097/ncm.0b013e318218845b