doctoral dissertation, Kent-Wilkinson (2008, 2009) described forensic nursing as a complex role with conflicting ideologies, role tensions and identity issues. These dual roles were applicable to forensic nursing practice in general, but also to care and concepts of specific subspecialties. Mason & Carton (2002) published similar findings regarding a dual role component to forensic nursing. They applied this concept specifically to forensic psychiatric nursing and found the dual roles were often contradictory yet equally important and necessary to forensic psychiatric nursing practice. DuMont & Parnis (2003) also discussed dual role and role conflict related to the subspecialty of sexual assault nurse examiners. These authors found conflict to arise between the dual roles of providing care and collecting evidence for forensic nurses. 19 Forensic nurses perform functions of nursing plus functions often attributed to another profession such as law enforcement (e.g., forensic technicians or crime scene investigators). For example, forensic nurses collect items that may hold evidentiary value in a criminal investigation or judicial process, functions typically associated with law enforcement units such as crime scene investigations units. This may result in intra-role conflict within the nurse and inter-role conflict between nurses and other RNs. Additionally, misconceptions of roles and unclear role definitions may lead to role conflict between providers and other multidisciplinary professionals (e.g., law enforcement officers). Value differences may also come into play to further compound the issue. The dual and conflicting roles of care and custody are the most recognized in current forensic nursing literature. Forensic psychiatric settings are secure custodial environments and forensic nurses must provide care and maintain custody (e.g., United Kingdom). In other forensic psychiatric settings, there may be correctional officers for the purpose of custody and security where conflicting professional values may result in role conflict and confusion (Mason, 2002). Forensic nurses in these settings recognized the need for a practice grounded in the core values of nursing. This led to subsequent discourse in the literature of forensic patients needing care and custody, not one or the other (Sekula, Holmes, Zoucha, Desantis, & Olshansky, 2001). Principles of public health are part of forensic nursing education and conflicts may arise between a clear duty to an identified, individual patient and a sense of social responsibility to others. For example, this might include the health and safety of those close to the patient, an extended community associated with the patient, or even to the public at large (Kent-Wilkinson, 2008). There are also considerations related to the legal system that may create another sense of duty. Forensic nurse examiners may experience a dual-role conflict or confusion as both caregivers and evidence collectors (Dumont & Parnis, 2003), between providing care and 20 maintaining chain of custody, and providing care and serving as fact/expert witness in the courtroom (Kent-Wilkinson, 2009). Lastly, role confusion may surface from the multiple and often conflicting expectations of others in the forensic nurse’s social environment. When expectations by employers, colleagues, outside groups and self are consistent, they reinforce each other, and role definitions are stable, motivation increases, job satisfaction is higher, and productivity is increased. When these expectations are inconsistent, it can lead to role confusion. When role confusion is left unaddressed, it can lead to role conflict thereby increasing stress, anxiety, and burnout with a reduction in job satisfaction (Benne & Bennis, 1959; Fain, 1987; Rosse, 1981; Tarrant & Sabo, 2010). Dual Duties within a Single Role as an Alternative to Dual Roles or Dual Loyalties Literature describing the nurse executive specialty role, describes nurse executives as experiencing conflict between nursing values and non-nursing values and the challenges related to prioritizing these dual responsibilities. Among nurse executives, the conflict arises between the duties to the organization and duties to the nursing profession. These competing priorities can lead to role conflict (Tarrant & Sabo, 2010). For forensic nurses, these competing responsibilities are often described as dual role or loyalty – or as nurse versus evidence collector. This again highlights the need to clarify if these are in fact dual roles or normal expectations of an integrated specialty role. Although dual loyalty has been explored in nursing and medical literature, the concept itself has not been clearly defined (ANA, 2015). Dual loyalty is often depicted as having obligations to the patient while at the same time having obligations (formal or informal; explicit or implicit) to act on behalf of another entity. The interest of the patient and this additional entity may be in conflict. Examples of dual loyalty can include patient versus managed care interests 21 (e.g., controlling healthcare costs), individual patient versus public health interests (e.g., reporting of communicable diseases), patient privacy versus risks to a third-party (e.g., a patient with psychiatric illness threatening the safety of others), or a patient in conflict with his/her employer (e.g., occupational health concerns versus costs of employee safety measures). These situations involve a dual loyalty (duty) to a third-party