title: The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway.
abstract: BACKGROUND
  The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality's market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPM-inspired municipal executive leadership.
  
  
  METHODS
  This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation.
  
  
  RESULTS
  Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality's hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership.
  
  
  CONCLUSIONS
  The priorities of municipal senior management and the focus of the municipality's care service need clarification in the light of this reform. The voices of those at the frontlines of the caring services need to be heard as the restructuring of the caring services may have implications both for funding allocation and for the quality of patient care.
authors.affiliation: Department of Health and Care, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Campus Narvik, Narvik, Norway.
authors.forename: Wivi-Ann
authors.identifier: 0000-0003-4839-5702
authors.initials: WA
authors.lastname: Tingvoll
authors.affiliation: Faculty of Professional Studies, Nord University, Bodø, Norway.
authors.forename: Torill
authors.initials: T
authors.lastname: Sæterstrand
authors.affiliation: Department of Health and Care, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Campus Narvik, Narvik, Norway.
authors.forename: Leon Mendel
authors.initials: LM
authors.lastname: McClusky
keywords: Community health care service; Nurse leaders