Background: The goal of the Cooperation Reform is to transfer a larger part of the health care service to the municipalities. The pressure is increasing on the health care service in the municipalities – especially on the home care service. Aim: To gain knowledge about how nurses experience and manage the challenges in their daily work in the home care service as a result of the new reform. Method: Grounded Theory. Data was collected through participating observation and qualitative interviews with 11 nurses in the home care service in two municipalities. Results: The main challenges of the nurses in the home care service are making difficult decisions in the clinical practice in the home care service. These decisions involve making valuations of ethical competence, and a follow-through of a complicated practice and priorities. Conclusion: This study shows how the Cooperation Reform has contributed to the increased pressure on the home care service – in the form of time reductions and a larger field of responsibility for the nurses. In addition, there is a need for an increase in competence. The study contributes to differentiate the understanding of the home care service.