The iam with this study was to obtain an understanding of how middle managers in private elderly care experience their leadership and its inclusive requirements. The study has also investigate how middle managers in the private elderly care take into account the company’s profit interest in relation to nursing ethics and quality requirements. Our study was conducted by qualitative research through semi-structured interviews in four middle-sized municipality in the southern part of Sweden. A total of seven middle managers were interviewed. The results showed that the middle managers in private elderly care has a complex leadership with many important responsibilities. The conclusion highlights that middle managers in the private sector have many possibilities like shorter decision paths and freedom of action. The struggle for the middle managers is to implement the management's decisions that they don't agree with. The conclusion also include that the middle managers perceives the financial goals of their organization as something positive regardless of whether they perceive the profit interest as noticeable or not. The middle managers have plenty of ways to quality assure care for their care recipient. Lastly the middle managers show that their leadership is furtherance to prevent the emergence of ethical dilemmas.