Exploring the scope and efficacy of nurse navigators in the care of individuals with complex care needs associated with chronic conditions: A systematic review.

BACKGROUND: The rising prevalence of chronic conditions has heightened the challenges of managing individuals with complex care needs within health systems. OBJECTIVE: To explore the scope and efficacy of nurse navigators in caring for individuals with complex care needs associated with chronic conditions. DESIGN: A mixed-method systematic review was conducted following the Joanna Briggs Institute convergent segregated integration methodology. METHOD: The review included qualitative, quantitative, and mixed-methods primary studies. Six databases were searched from inception to April 23, 2025. The databases were searched using Medical Subject Headings and keywords such as 'nurse navigator', 'chronic conditions' and 'complex care needs'. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Randomised controlled trials were evaluated using the Cochrane risk-of-bias tool version 2 and non-randomised studies using the Cochrane risk of bias in non-randomised studies-of interventions tool. Narrative synthesis of quantitative data, and qualitative content analysis were undertaken, followed by a convergent segregated integration of quantitative and qualitative data. RESULTS: In all, 49 studies were included, of which 22 were quantitative, 17 qualitative, and 10 were mixed methods. Data synthesis identified three overarching themes: (1) perceptions of nurse navigator scope and efficacy, (2) healthcare utilisation, and (3) organisational challenges. The scope of the nurse navigator role was broad and variably defined, however core functions such as care coordination, continuity, and improving access to services and providers, were consistently described. Evidence of nurse navigator efficacy was centred on patient empowerment, education, comprehensive care and caregiver support. However, healthcare utilisation outcomes, including hospital admissions, emergency department presentations, and length of stay, were inconsistent, indicating nurse navigator involvement was not reliably associated with measurable improvements. Blurring of role boundaries and responsibilities, variability in team integration, and diverse outcome measures, limited comparability across studies, making robust evaluation of nurse navigator efficacy challenging. CONCLUSION: Nurse navigators combine advocacy, holistic support, and coordinated, relationship-based care to reduce fragmentation and strengthen continuity for individuals with complex care needs associated with chronic conditions. Realising the full potential of nurse navigator roles requires a standardised definition, that protects role boundaries and recognises their contribution to complex, chronic condition management. By clarifying the core scope of nurse navigators and highlighting the organisational factors that shape their impact, this review offers a foundation for strengthening design of the role, integration into practice, and evaluation. The review protocol was registered on PROSPERO (2025 CRD420251025064).