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Abstract Background Research on quality of care revealed nurse-to-patient ratio and skill mix served as key elements in quality of care. However, those studies were done in countries where nursing workforce had reasonable proportion of professional nurses with bachelor degrees. Findings of these researches may overlook challenges in health system as well as the nature of nursing service in small island low-income countries that has a huge proportion of auxiliary nurses. Working in under-sourced places, nurses in Timor-Leste might have different viewpoints on what aspect contribute to quality of care. Methods Focus group discussions (FGDs) were done in 2017, in three districts that included staff nurses and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method. Results Two themes were emerged from the FGDs data: “patients as the center of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also covered the importance of employing nurses’ value system in order to uphold quality of care. The second theme included quality care milieu amplifying distinctive factors facing health system in under-resources places. Problems related with facility infrastructure, equipment and supplies, financing, management, and staffing were narrated. While an inadequacy or a deficiency of these factors implies the country’s struggles to maintain a functioning health care facility, it incapacitated nurses to improve quality of care. Conclusions Compared to nurses in countries with better skill mix, nurses in under-resources places and small island low-income countries face different challenging situations that go beyond nursing realm, forcing nurses to describe quality care uniquely. Findings from this study provide evidence that it is urgent to develop policies of human resources for health (HRH) within the context of the health policies that contributes to professional management of the largest cadre, thus strengthens their ability to improve patient care service.