This study will address the several knowledge gaps by 1) the focusing on the contribution of RNs, and 2) investigating of quality of life(QOL) of residents, not only quality of care. RNs and other alternative nursing staffing have been categorized as one group although they can not replace one another in preparation to provide care or in legal authority to provide care. Donabedian’s framework (structure, process and outcome) was selected as the conceptual framework.

Since the relationship between the independent variables and dependent variables will be examined this study will be a descriptive correlational study.  The independent variables will be total Per Resident Per Day nursing hours (PPD), skill mix hours PPD and turnover rate of nursing staff. The data for the dependent variables will be collected by the researcher using the QOL section in the MDS version 3.0. The setting will be the 12 for profit and 12 not for profit NHs that are certified for Medicare and Medicaid within a 50 miles radius of Iowa City. Sample will be 10 residents in the 24 NHs (N= 240) with random recruiting.
      Hierarchical Linear Modeling will be used to analyze data. HLM permits simultaneously estimating effects at the individual level and the nursing home level. This study will examine the analysis of NHs, but the impact of resident characteristics on outcomes should be also considered.