Developing and testing a case manager impact profile

The purpose of this study was to develop and test an instrument to measure the activities and perceived outcomes of rural nurse case managers in hospital settings. The Nurse Case Manager Impact Profile (NCMIP) is a 69-item, Likert-type questionnaire organized into two scales, the Activity Scale and the Outcome Scale. Content validity of the NCMIP was endorsed by four experts in nursing case management and rural nursing. Its validity and reliability were assessed in a survey of nurse case managers (N = 302) in nonfederal, rural, U.S. hospitals. Internal consistency was high for the five Activity subscales and for the Activity and Outcome scale: Individual Advocacy (alpha = .85), Clinical Practice (alpha = .85), Teaching (alpha = .89), Research (alpha = .86), System Advocacy (alpha = .85), Activity (alpha = .93), and Outcome (alpha = .92). Factor analysis with orthogonal varimax rotation resulted in clear confirmation of a five-dimensional Activity scale and of two of the five subscales. Factor solutions, however, suggested a reconceptualization of three subscales into three new factors with unifying themes. Although factor solutions confirmed two of the four dimensions of the Outcome Scale, items for the remaining two dimensions reconfigured to suggest overlapping domains. Psychometric testing suggests that the NCMIP warrants further development and testing and, like any new instrument, should be used with discretion and caution.