This study used qualitative fieldwork and survey methods to identify role behaviors and attendant roles of nurse case managers practicing in the broker model. Role theory known as symbolic interaction was selected as the study's conceptual framework. Symbolic interactionism posits that participants can ascribe meaning to interactions, provide responses based on meaning, and adopt meaningful role behaviors as a result of the interactions.

The primary data gathering strategy was the ethnographic interview approach. Four nurse case managers randomly selected from offices of a national case management corporation participated in interviews. The investigator analyzed and manually coded the verbatim text using an interactive, menu driven computer program called The Ethnograph to assist with the mechanical aspects of data analysis.

A survey instrument with thirty-eight items was developed from analysis of the ethnographic interviews. The instrument was mailed to a systematic random sample of 100 nurse case managers practicing in the broker model.

Using detailed data collection and analysis procedures, findings related to the (a) characteristics of the study's respondents, (b) instrument validity and reliability, and (c) the study's six research questions were identified and analyzed.

Analysis revealed study respondents (n = 58) were all females in their forties, had practiced nursing for at least 20 years, and had practiced as a case manager for an average of only three years. For 43% of the respondents, the highest level of education was either a diploma or an associate degree in nursing.

The roles identified were: public relator, educator, expeditor, monitor, problem-solver, explainer, negotiator, planner, communicator, contactor, recommender, broker, researcher, assessor, documenter, and coordinator.

Analysis of the responses regarding source of learning of the nurse case manager behaviors revealed that across all behaviors, the majority of learning occurs on the job rather than through formal education.

Collectively, these findings suggest numerous educational and research actions to support continued clarification and specification of nurse case manager roles.