Introduction Nursing practice in skilled level GREEN HOUSE® homes is the focus of this report. The report describes a study that was conducted with 11 of the 14 GREEN HOUSE® homes that have skilled care settings and had been operating at least six months in 2008, when the project began. The study was conducted during 2008-9. The impetus for the study was a concern expressed by many in the nursing community that the GREEN HOUSE® model might result in a weakening of professional nursing oversight. The concern arose from the GREEN HOUSE® vision and implementation of an empowered front line worker (the Shahbazim) and the elimination of a direct reporting relationship between the Shahbazim and the nurse. Unlike other skilled care settings, the front line workers in the GREEN HOUSE® homes do not report directly to the nurse. Their supervisor is, in all but one home, not a nurse. There were concerns within the nursing community that GREEN HOUSE® nurses could be marginalized in both their oversight of residents and their ability to supervise front line workers. Much of the care provided by front line workers in long term care settings is nursing care that has been delegated to front line workers. CNAs working in all 50 states engage in activities that are delegated from the registered nurse. This report includes a brief description of the study and an overview of the findings, focusing on nursing practice in the GREEN HOUSE® homes that participated in the study. The report describes variations in how nursing has been structured in the GREEN HOUSE® homes and some of the consequences of these variations for both staff and residents. Implications for care and work life quality are also identified and discussed for each of the GREEN HOUSE® nursing model variations.