Background Nurses need to exhibit stronger leadership by taking more responsibility and accountability to improve healthcare quality and patient safety. Aims The aim of this study was to determine the association between quality of care and leadership styles and practices, and whether the characteristics of nurses influence this interaction. Methods We conducted a multicentre cross-sectional survey of 655 nurses working on clinical wards in Dutch university medical centres in 2018. Results Transformational leadership was significantly associated with quality of care which explained 5.9% of the total variance ( R2 = 0.059 F = (11,643) = 3.726, p = 0.011), and the nurse characteristics gender, profession and type of practice area were significant influencing factors. Nurses rated the quality of care (mean (M) = 7.7, standard deviation (SD) = 1.3) as moderate and they showed moderate levels of transformational leadership style (M = 3.7, SD = 0.5) and transformational leadership practices (M ≥ 6.2 and ≤ 7.6). Conclusions When considering quality improvement on clinical wards strategic managers need to be aware of the fact that leadership is associated with quality of care and that nurse characteristics influence this association. The findings indicate a pressing need for education and training for nurses in how to develop leadership and raising the awareness among strategic managers about the importance of leadership in health care is recommended.