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In modern healthcare, the middle manager closest to clinical practice is expected to innovate. The middle manager develops their capacity and ability to lead through personal development processes that are supported by the environment. When middle managers in healthcare are able to develop new capacity and skills, it is because there is a personal development process that is supported by the environment. By organising learning processes that support the manager's confidence in leadership, the manager's capacity to interact in the complex healthcare system can also increase. This requires an empowering approach from the organisation's top leadership. Change management, based on organisational values, networks, trust, respect, clear structures and frameworks, as well as support and feedback, must be present. Middle managers' journeys towards excellent nursing care, through which they actively contribute to the employees' competence development and demand the development of nursing care in close collaboration with the self-managing clinical nursing specialists, is a process well underway at Lillebælt Hospital, and this is exemplified in this article. [ABSTRACT FROM AUTHOR]