With changing staffing structures and persistent quality concerns in nursing homes, registered nurses are challenged to ensure that appropriate care is delivered. We describe differences in the nurse practice acts (NPAs) and related administrative code for all 50 states and the District of Columbia for licensed practical nurse (LPN) delegation and supervision. Next, we explore relationships between these differences and quality measures from the Centers for Medicare & Medicaid Services for United States nursing homes, using 2007 data. Findings indicate that how boards of nursing (BONs) regulate LPN scope of practice is directly related to care quality. States with NPAs stating that LPN practice does not include delegation and supervision have better care quality outcomes. Further, the greater the extent to which BONs are either silent or permissive in these critical areas of LPN practice, the poorer the state performance on care quality.