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Background  The nurse leadership of a hospital is identified as the single most important aspect of the practice environment that impacts nurse outcomes. When nurses are satisfied with their jobs, they tend to remain with their employers and become more productive in their workplaces.    Objectives  This study aimed to investigate the relationship between leadership, job satisfaction and intentions to leave among registered nurses (RNs) working in hospitals in the North West and Free State provinces of South Africa.    Methods  A cross-sectional survey design was adopted. The population ( N  = 680) with the sample ( n  = 204) included RNs in medical–surgical units in both private and public hospitals in the two provinces. Data were collected using the RN4CAST questionnaire.    Results  RNs were satisfied with the items pertaining to leadership except for praise and recognition (55.7%). They also indicated high levels of overall job satisfaction (70.5%) but were dissatisfied with wages (50%), study leave (40.9%) and opportunities for advancement (40.1%). Furthermore, 46.1% of the RNs intended to leave their current hospitals. The results indicated a relationship between leadership and job satisfaction ( r  = 0.47;  p  = 0.00) and between intention to leave and job satisfaction ( d  = 0.50).    Conclusion  The nurse managers played a significant role influencing RN’s level of job satisfaction, while job satisfaction was highly correlated with intention to leave. The nurse leadership can improve job satisfaction by giving praise and recognition to the RNs for jobs well done, and RNs should be afforded the opportunity to advance their careers through further studies.

Leadership, job satisfaction and intention to leave among registered nurses in the North West and Free State provinces of South Africa