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Role Conflict in Case Management and its Relationship to Cultural Nursing
The Job Stressor Role Conflict in Case Management and its Relationship to Cultural Nursing
Racquel Wright
NUR 4010
New York City College of Technology
Professor Falk
November 28, 2012
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Role Conflict in Case Management and its Relationship to Cultural Nursing
Role conflict occurs in almost every profession especially those including multiple
factors and individuals lives. Role conflicts may include religious, ethical, and personal conflicts
that occur from day to day for case manager. To ensure that the case manager is an effective at
what he/she does, they must first evaluate their own issues and beliefs before being able to
effectively help others make decisions regarding their health without imposing their own
personal biases. In this paper I will discuss how the job stressor role conflict is and why it is of
importance to case management. I will describe how having role conflicts can influence the case
manager's practice of being culturally competent. I will also discuss how being culturally
competent can improve the case management practice. Overall, case managers are faced with
this problem and found prospective on how to deal with such dilemmas without offending
different cultures from their own in the process.
What is role conflict? Role conflict is a job stressor that occurs when "case managers
execute their role one way while the defined role is something else; that is, when there is a
mismatch between role definition and role acceptance" (Powell & Tahan, 2010). Role conflict
has also been defined as stress resulting from multiple job requirements that are perceived as
incompatible because divided loyalties or accountabilities (Smith, 2011). Role conflict and strain
occurs from many different factors in the job's description, ranging from the case manager's
professional identity and self image, interactions, relationships, time task orientation and
business and financial objectives. There are also other means for role conflicts to occur for the
case manager in the workplace.
Role conflict can occur as ethical dilemmas. For example, as a case manager, the job
consists of performing a balancing act, framing contentious opinions, speaking for the vulnerable
and assuming responsibilities without power are a few tasks of the case manager. The case
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Role Conflict in Case Management and its Relationship to Cultural Nursing
manager will have to deal with frail patients without sufficient funds to continue to receive care
from the healthcare facility and no access to the essential resources they may need for their
health. The case manager is then faced with the situation of having loyalties to the facility, their
employer, being paid and the patient, as their advocate, who cannot fund their expenses (Smith,
2011). The example just given is a frequent dilemma experienced by the case manager. Role
conflict mainly occurs due to role ambiguity on the case manager's part and them assuming roles
that are a part of their job description.
What is role ambiguity? Role ambiguity is according to Jamison et al. the basic socialpsychological problem encountered during implementation. Many case managers experience
anxiety and confusion performing their job due to this role ambiguity. Now the question is what
the case manager's job is exactly. Currently, according the ANA code of ethics, the role of the
nurse case manager is advocating for the patient's health, safety, and their rights. To help lessen
the levels of ambiguity in the case management profession, the clinical practice of the case
manager has to have clearer defined boundaries. Also ethical committees should be readily
available to the case managers and as a requirement case manager should be trained in
mediation, negotiation, and conflict resolution in order to help lessen this role ambiguity and
make them more culturally competent (Smith, 2011).
Being culturally competent is imperative as a case manager. The case manager being
culturally competent can help lessen the frequency of role conflicts they may have in the work
place due to misconceptions they many have of the different cultures they meet. How should the
case manager go about becoming culturally competent? In order for the case manager to become
cultural competent, the case manager has to be informed of the ethno-cultural dynamics of the
patient's in order to make informed decisions regarding what best fits the client's needs and
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Role Conflict in Case Management and its Relationship to Cultural Nursing
lifestyle. There are many different factors including the client's age, class, cohort amongst the
residents which can lead to misunderstandings and conflicts. Also different cultures
communicate differently and have different work habits and understandings of how care should
be provided and its overall quality. As a case manager, he or she has to be mindful and consider
all of these factors without compromising their quality of work and offending others they are
exposed to (Werkmeister-Rozas & Klein, 2009).
Role conflict in case management that is influenced by cultural competence can be
demonstrated in the following example. An 84-year-old man, James, has a diagnosis of
pancreatic cancer and was given 3 months to live. The MD has provided him with the option of
aggressive radiation with 4 cycles of chemotherapy to help reduce the size of the tumor. His
family wants anything that is possible to be done for him, to be done while James does not want
to fight anymore. The case manager has to knowledge of this situation and he knows that the
radiation and chemo will kill James before the cancer actually does. He also feels conflicted
because of this ethical conflict. On the exterior, it may seem that the case manager is supporting
the death of James, but he is actually advocating for him. After listening to James' concerns, it is
up to him to listen to what he wants essential and use the knowledge he has to explain to the
family what may occur if they go through with the treatment and the suffering he will
experience, which in all actuality, will be worse.
Cultural competence can dramatically reduce role conflict. Cultural competence in case
management improves the case management practice in many ways. Being culturally competent
isn't only about the acquisition of skills but also development of sensitivity that acknowledges
that there is always difference when within cultural groups. Case managers play a pivotal role in
navigating the complexity of diversity in the worker- client relationship. Therefore the case
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Role Conflict in Case Management and its Relationship to Cultural Nursing
manager has to seek the highest level of cultural competency as a part of the profession. To be
effective in cultural competency and reduce role conflicts, the case manager to first evaluate
themselves and recognize how their beliefs, attitudes and feelings may influence their decision
making. This requires them to be aware of and connect to multiple aspects of an individual's
cultural makeup including the way they may grieve, celebrate, help, and protect and plus the
already know language, values, customs, and traditions (Werkmeister-Rozas & Klein, 2009).
Because cultural competence is important to case management it has to be implemented in the
workplace to reduce the conflict between the case managers, patients, other healthcare providers,
the insurance company, and the and healthcare facility. For example, members of the Jehovah
witness religion do not favor blood transfusions. A 24-year-old patient, who is Jehovah's
Witness, was in a car accident and lost masses of blood during her life saving surgery but it is
vital that she has this blood transfusion in order to recuperate from the surgery. The case
manager has to be aware of this religious group's belief systems and then has to explain the
importance of this life saving procedure for this individual because she is young and has her
whole life ahead of her. The case manager knows his position and his beliefs and can therefore
effectively explain all aspects of the procedure to the family without any bias influencing them
and they agree to the procedure. This example shows cultural competency can improve the case
management practice by reducing role confusion and ambiguity, establishing a rapport with
patient's, their families, and coworkers.
The way an individual sees optimum health varies. Health and illness issues are concepts
based on how the individual perceives, experiences, and manage health and illness based on their
cultural group. What one group may perceive as respectful care another group may find it
disrespectful, insulting, and offensive. This is why implementation of how to provide culturally
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Role Conflict in Case Management and its Relationship to Cultural Nursing
competent care is essential in the workplace. As a healthcare provider, the main role is providing
care that crosses all cultural boundaries while being culturally sensitivity. This is why cultural
competence is important. This type of care prevents conflicts in the decision-making process the
case manager may experience that may leave him or her frustrated and the patient feeling guilty
and alienated (DeRose & Kochurka, 2006). A benefit of cultural competence includes effective
in successful patient-centered transition of care (National Transitions of Care Coalition, 2012).
To first begin the path to cultural competency for each patient the case manager has to evaluate
the patient's history, physical status, their personal views of health and the care they should
receive, and their functional level to help create a plan of care specifically for that patient. This
overall leads to better patient outcomes because of the better care plan (DeRose & Kochurka,
2006).
Role identity is the main goal of the case manager to provide the proper services to each
client. To also help do so the case manager should adapt cultural practices that neither helps nor
hinders. This also increases the likelihood that the patient will adhere to the plan of care after
discharge because it is consistent with their cultures values and practices. The case manager also
has to obtain background information of the patient's culture. This cultural knowledge helps the
case manager and the patient develop a relationship, prevent any misunderstanding by providing
the opportunity to ask the right questions, and identify what the patient values in order to
incorporate that into their care as well (DeRose & Kochurka, 2006).
Some characteristics the case manager can adapt as a part of their culturally competent
includes being caring empathic, openness, and flexibility. Also the case manager can learn new
or improve their communication skills. This can be done by adjusting their eye contact pattern,
space, and conversation space to that of the patient's family to promote the relationship building
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Role Conflict in Case Management and its Relationship to Cultural Nursing
process. The case manager should also allow the patient to express him or herself openly and
freely. This allows the case manager to gain an understanding of the patient's views and the
patient to speak without the feeling of having to defend himself or herself. No one is perfect and
when dealing with different ethnic backgrounds, problems may still develop. When this occurs,
the case manager should apologize and express regret about their offensive behavior and their
desire to learn more to prevent this error from occurring again (DeRose & Kochurka, 2006). All
the views above expressed are ways cultural competence reduces role conflict and confusion and
improves the case manger's efforts to building a plan of care of every unique individual.
In conclusion, case managers experience all types of conflicts while working with
multicultural patients and their families. As the case manager, one encounters individuals from
all parts of the world with different beliefs and it is up to them to be culturally competent in
those different areas to establish the best care plan for those different individuals based on their
different lifestyles. Building a rapport, knowing the proper ways to communicate, and
understanding what that individual's values are all vital factors in case management and cultural
competency. By the case manager doing the background information of the patient's cultural
beliefs and values, this lessens the possibility of him or her experiencing role conflict. In
addition, the case manager has to also evaluate his or her beliefs to ensure that he or she is not
experiencing any biases, which can influence the outcome of the patient's care plan and whether
or not they may adhere to it. These are just a few examples of how role conflict can influence
cultural competency in case management.
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Role Conflict in Case Management and its Relationship to Cultural Nursing
References
DeRose, N., & Kochurka, K. (2006). Implement culturally competent healthcare in your
workplace. Nursing Management , 18-26.
National Transitions of Care Coalition. (2012). Cultural Competence: Essential Ingredient for
Successful Transitions of Care. Retrieved November 22, 2012, from National Transitions
of Care Coalition:
http://www.ntocc.org/Portals/0/PDF/Resources/CulturalCompetence.pdf
Powell, S., & Tahan, H. (2010). Case Management: A Practical Guide for Education and
Practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Smith, A. (2011). Role Ambiguity and Role Conflict in Nurse Case Managers: An Intergral
Review. Professional Journal of Case Management , 182-196.
Werkmeister-Rozas, L., & Klein, W. (2009). Cultural Responsiveness in Long-Term-Care Case
Management: Moving Beyond Competence. Springer Publishing Company , 2-7.