This paper reports on research that tells the story of nurse managers’ attempts to provide a 24-hour service. Although research was contextualized within the National Health Service in the United Kingdom, the outcomes are not merely about the NHS. It is argued that middle managers, possessing delegated responsibility, are considered to be empowered. Such empowerment is accompanied by widely experienced anxiety. An escalatory and contagious process is observed which exaggerates ‘normal’ stress and challenge among middle managers into a state of selfperceived angst. It is argued that anxiety is, in effect, delegated, a process which serves to partially relieve superiors of anxiety-generating responsibilities. In contrast to arguments that players in bureaucracy ‘conspire’ to ensure that responsibility and consequent anxieties are largely held by the organizational elite, this paper argues that this traditional Weberian notion is worthy of challenge. Findings are based on qualitative data from an ethnographic research project that immersed itself in the minutiae of middle managers’ organizational lives.