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“Joe” a well respected RN with many years of experience, worked in the intensive care unit. One afternoon a patient was brought to the unit immediately post heart surgery. Joe assumed his care, and began his assessment. Shortly after the patient’s arrival, the surgeon came in to see that patient.
The surgeon decided that he needed to replace a blocked central line, although the patient did have two patent peripheral IVs. Joe assisted the surgeon with the line placement, then called for radiology to come up and confirm line placement, as per protocol. Just as Joe heard the radiology tech coming, the patient developed asystole. Joe and the surgeon instituted ACLS protocol. When the surgeon called for a medication to be pushed, Joe went to push it via the patent peripheral IV, as placement of the central line had not been confirmed. The surgeon yelled ‘No! In the central line! Push it in the central line!’ Joe responded, ‘The central line placement has not been confirmed, so it has to go through the peripheral.” At this point, the surgeon yelled, “I want it through the central line, and you have to do what I say, because I’m the physician!” Joe yelled back that he was not going to risk his license just because a physician refused to follow protocol. He told the surgeon that he would push it through the peripheral line. The surgeon was livid, but made no attempt to push the med himself, so Joe pushed it through the peripheral line. The patient was then revived.
Joe and the surgeon continued to argue after the patient was resuscitated, to the point where other staff feared a fist fight would ensue. The house manager, an RN, was called in. Joe explained the situation to her. The surgeon said “I told him he was a nurse and he had to do what I told him to do. He’s not going to lose his license or get fired as long as he does what I tell him to do. But he won’t listen.”
The house manager responded. “Well, the hospital policy does say that central lines cannot be used until placement has been confirmed by radiology.” The surgeon went berserk, yelling at everyone. The house manager then said “well, if you want, we can change that policy so if a physician says it’s ok, the line can be used without confirmation.”
What do you think of the house manager’s response to the situation?
What, if anything, do you think Joe should have done differently?
How would you have responded?

What do you suggest should be done about this proposed change in the policy?