Healthcare professionals moving into organizational manager positions is no longer seen as unusual within the course of a career. However, despite a continuing focus on the potential for healthcare professional managers to drive system level innovation, extant research suggests that potential is limited by the tensions inherent in the role, creating emotional turbulence and a lack of organizational influence. In this paper we explore these tensions as resulting from unavoidable breaches of social contract, which all healthcare professional managers must navigate. Drawing on the case of nurse managers, we present findings from 120 hours of ethnographic observation and 79 interviews conducted over three years. We identify four types of social contract breach: minor; actual; anticipatory; and renunciation; and present a model exploring the outcomes and relationship between each of these breaches over time. In doing so we give insight into the emergence of a new professional group we call ‘agents of innovation’, who hold the potential to drive system level innovation.
