The burden of chronic illness is increasing globally as a result of increased life expectancy, unhealthy lifestyles, and advances in medical interventions and treatments. Therefore, people living with chronic conditions, and their families, will have to assume greater responsibility in managing such conditions. However, to do so they require appropriate support from healthcare services. This article explores some of the tensions that hinder the self-management of chronic conditions. It emphasises the importance of individuals and their families having the desire, and being enabled, to assume an active and decisive role in the management of chronic conditions. Nurses have a role in enabling patients to optimise their self-management skills, but organisational constraints in healthcare services, as well as constraints in nurse training and nursing roles, may mean that nurses are unable to fulfil this role. This article considers some of the factors that may limit the development of patient and nursing roles in relation to self-management of chronic conditions.