Does a med spa in Nebraska need a medical director?

Short answer
The cited rules do not settle this — they only define delegating as transferring the authority, responsibility, and accountability for nursing interventions, and let an RN delegate them; no cited rule requires a med spa to have a medical director.

Nebraska defines delegation in nursing terms — transferring the authority, responsibility AND accountability to perform nursing interventions — and places delegating, directing and assigning within the registered nurse’s own practice, bounded by the Nurse Practice Act. It also puts an affirmative duty on every credential holder to report anyone they have reason to believe is practicing without a credential. Separately, the Board’s own rules bound the cosmetology licenses: the practice of esthetics is upon the skin or epidermis, and neither esthetics nor cosmetology includes using injectables and lasers. That rule names those two modalities and does not name microneedling.