Current federal minimum staffing levels for certified nursing homes require one RN for at least eight hours per day, seven days per week, and one licensed nurse (RN or LPN) on duty the rest of the time. State minimum staffing level requirements for nursing facilities vary considerably. Consequently, nurse skill mix and nurse staffing levels per resident may vary significantly across facilities, making it important to consider these variables.

The purpose of this study was examine the relationship between nurse staffing levels and care quality in rural nursing homes, and to assess potential differences between hospital-based and freestanding rural nursing homes.