There is limited clinical research on the effectiveness of alarm management strategies and nursing behaviors related to alarms in clinical settings. As many as 76% of physiological monitor alarms are overlooked as clinically insignificant by nursing staff. Excessive alarms may impact patient outcomes and cause cognitive overload for nurses that can result in medical errors and missed patient resuscitations. The purpose of this systematic review was to rate alarm management studies on level of evidence for interventions, nursing responses to alarms, and impact on alarm fatigue behavior. The nursing role effectiveness model guided this project. Twenty-seven studies were reviewed to analyze outcome effectiveness by addressing structure, process, and outcomes related to how the roles of the nurse affect nurse-sensitive patient outcomes. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Cochrane guidelines guided study selection and analysis. A second reviewer collaborated on the search strategy and provided an independent review of the identified literature. The effectiveness of alarm management was difficult to determine because most studies were descriptive, cohort, or nonrandomized trials. Review findings did not support a relationship between the amount of alarms and increased alarm fatigue behaviors. Findings indicated that nurses' attitudes and alarm fatigue behaviors are present globally and have not significantly altered since reduction strategies were implemented. The findings may impact social change by decreasing nurses' stress levels related to cognitive workloads, improving patient outcomes, and supporting increased levels of nurses' workforce satisfaction.