On becoming a manager and attaining managerial integrity

Purpose The call for cuts and streamlining in health organizations has resulted in middle managers having more responsibilities. The main aim of this study is to explore and understand the way middle managers in Swedish health care organizations handle multiple obligations and continuous challenges. Design/methodology/approach Middle managers in health organizations were interviewed in an open‐ended, interactive mode. The transcribed interviews were analysed using grounded theory as the method of study. Findings The participating managers started their careers as nurses or physiotherapists and they describe their experiences of transition in role taking and transformation of earlier approaches to work assignments. An understanding of a process of managerial development is identified. During this process, the subjects are going from “being prepared” to “defining limits”, from “action” to “wait‐and‐see”, gradually regaining self‐respect and establishing authority, all to attain a non‐negotiable managerial integrity. Practical implications The findings can be used to support first line managers in health care, who often leave their positions in the early stages of their managerial career, as well as middle managers in their managerial development. Originality/value The development of managerial integrity, with support from findings in in‐depth interviews, has not been described until now.