You have just completed a well-baby check on a 6-month-old in the office where you...

MCCQE ELOM objectives emphasize patient safety, appropriate delegation, and respecting professional scope of practice. If a nurse states an activity is outside their scope (or they are not authorized/competent in that setting), the physician should not pressure or coerce them to perform it. Delegation requires that the delegated act is permitted by regulation and workplace policy, that the person has the competence to perform it, and that appropriate supports/medical directives exist. Supervision alone does not make an out-of-scope act acceptable, so offering to “be present” does not address the underlying legal/professional boundary. Escalating immediately to the regulator is inappropriate without first clarifying the issue locally, and simply “refraining from asking again” fails to ensure the infant receives indicated care today.

The best immediate step is to ensure timely care by administering the immunizations yourself. Afterward, discuss the matter with the nurse to clarify clinic policy, required medical directives, training/competency, and how immunizations should be handled in this practice going forward (e.g., establishing protocols so authorized staff can provide vaccines safely).