This study aims to explore middle managers' perception of nursing professional competence within the Norwegian primary healthcare service, a sector vital for managing complex patient needs. Semi-structured interviews were conducted with four middle managers across different municipalities in Norway. Qualitative content analyses, following Graneheim and Lundman, were used for analysing the transcription of the interviews and the data collected. The qualitative content analysis revealed three main themes: the significance of advanced competence, challenges related to competence development and the necessity for defining advanced competence. The findings indicate that middle managers recognise the importance of advanced nursing competence in providing comprehensive patient care, notwithstanding challenges in manpower and competence enhancement. This research underlines the significance of investing in increased competence and improved management in primary healthcare and offers valuable insights for healthcare policy and practice to enhance patient care.