Due to the increasing level of acuity in today's long-term population, interventions previously found only in acute care are now becoming commonplace in the chronic care setting. These changes result from health care and reimbursement legislation, advances in medical technology and the overall increased life expectancy of the population at large. To meet these challenges, nursing leaders are making efforts to identify and anticipate patient care needs, and to implement educational programs for staff to meet those needs. One of those interventions, inotropic therapy, is being seen more frequently in the long-term care setting. This article describes how one facility managed the administration of inotropic agents to a patient with end stage cardiac disease, and some of the issues surrounding initiation of the drug.