Title: Leaders Approach to Change Background: The healthcare sector is large and complex with high rates of organizational change. Previous studies have linked negative employee outcomes such as increased rate of sickness absence with organizational change in mainly the specialist health care sector. Therefore the focus of this paper has been at middle managers in primary health care institutions. It is important to find out how to reduce sickness absence in the primary health care sector for several reasons: it already has a high level of sickness absence, it employs many people, and third, sickness absence will continue to increase if we do not take initiatives to prevent sickness absence. Aim of the study: We have chosen a two-parted problem, with a theoretical part and an empirical part, respectively: How does restructuring affect sickness absence? Which approach do managers take when handling sickness absence resulting from such changes ? Method: The thesis is a qualitative study based on semi-structured interviews with 16 middle-managers in the Nursing Administration in Oslo. Results: We found that uncertainty and lack of information increases the risk of sickness absence in a change process. The managers who had great comprehension of the Valley of Despair model felt that they had a better chance of success during uncertain events. Most of the managers had a transformational approach towards managing. They used individualized consideration for all their employees and focused more on trust and support. According to previous research, theories, and our findings, supportive management is valued by the employees and is indicated to be necessary for preventing sickness absence. Some had a more strict way of leading with use of reward and punishment, which leans toward a transactional approach. This could lead to a scare culture , which they thought could prevent sickness absence. It is important to know how to approach sickness absence and increase knowledge about change processes. Almost every leader emphasized the phrase from absence to presence , where they wanted to change the focus for sickness absence by focusing on the present employees instead of those absent. They did not mention professional development for the employees as a means to get more motivated employees to the degree we expected. Rather, they focused on creating a better work environment by taking different initiatives such as ensuring adequate information. Conclusion: Supportive management and motivation in combination with adequate information is necessary for a successful change process.