The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders (N = 87) and two focus groups (FGs) (N = 14). Results indicated staff were most confident handling preferences related to medication refusal (mean item rating = 4.1) and least confident in preferences related to smoking (mean item rating = 2.4). Staff were challenged in denying residents' preferences (mean item rating = 3.6) and worried about risk outcomes for residents or themselves (71.6%), reporting lack of policy and procedures to support them (48.1%). Survey results were enriched by FG themes: Establishing Person-Centered Values, Navigating Risk, and Operational Characteristics. Together, this information informed the development of a practice protocol to improve nursing competence in situations involving negotiation of resident and/or NH risks in care delivery. [Journal of Gerontological Nursing, 49(2), 7-12.].