Aim

The aim of this study was to identify first-line managers' approaches for maintaining low levels of sick leave among health care employees.

Introduction

One challenge in health care is the high level of sick leave among employees. High work demands and conflicting pressures characterize the work situation of both employees and first-line managers, with potential negative effects on work-related health.

Method

First-line managers at units with low and/or decreasing sick leave were interviewed. Thematic analysis was used to analyse the data.

Results

The managers took a holistic approach in meeting their employees' broader needs, and they were balancing high organisational demands through insubordination. To keep sick leave rate low, they created possibilities for the employees to influence their own working life through a present, visible and trustful leadership.

Conclusion

Managers responsible for units with low sick leave seemed to utilize a holistic approach with focus on their employees and prioritized needs of their employees before organisational demands from top management. Implications for nursing management First-line managers in health care can have impact on sick leave among their employees and create good working conditions, despite pressure from their superiors.