In many jurisdictions, legislation requires long-term care (LTC) facilities to have a registered nurse on duty 24 hours a day, seven days per week. Although considerable research exists on LTC nurse staffing intensity, no empirical research on this requirement exists. Our retrospective observational study in Saskatchewan compared facilities with 24/7 RN coverage to facilities with less coverage supplemented with various night-shift staffing models. Adjusted for nurse staffing intensity and other potential confounders, risk ratios associated with less-than-24/7 RN coverage supplemented with licensed practical nurse night-shift staffing were 1.17, 95% CI [0.91, 1.50] and 1.00, 95% CI [0.72, 1.39]; and with less-than-24/7 RN coverage supplemented with care aide night-shift staffing, risk ratios were 1.46, 95% CI [1.11, 1.91] and 1.11, 95% CI [0.78, 1.58], for inpatient hospital admissions and Emergency Department visits respectively. Findings suggest that acute services utilization may be negatively influenced by the absence of 24/7 RN coverage.