There is an expectation that the manager or head nurse
should set the tone for the care culture on the hospital
wards. But the head nurse’s role as creator of the culture
seems, in reality, to be limited to his/her confidence in the
personnel. Instead, there exist what the nurses called ‘‘the
strong personalities’’ who set the tone and influence the
care culture. The interviews contained stories about strong
individuals who are great patient advocates. They react
against poor decisions, strongly support their co-workers,
and enhance job satisfaction. But there are also strong
personalities who have a negative influence on the care
culture. They may spread dissatisfaction and be focused on
things other than patient care. One nurse told about strong