Case 31 Ghost Posting in the OR Discussion Question 1. What are the main facts of this case? The main facts in this case show that a register nurse in the OR discovered how Dr. Neuer’s is using techniques that are so detrimental for the hospital just because he wants to protect his block time. In addition, others surgeons who are part of the organization have noted that although the OR is usually empty, they have to go to others institutions to perform their surgeries. Furthermore, Dr. Neuer uses imaginary patients to fill in the time and availability for the schedule days in which he has to post certain surgical cases. The RN communicates all this matter to the administrator in charge of the OR. After further investigations, it is concluded that Dr. Neuer does not want anybody to know how is performing his job with inefficiency. While Dr. Neuer continues doing this practice, the hospital will be financially affected. 2. Which theory or theories do you believe best explain Dr. Neuer’s behavior? Bureaucratic theory can be used to describe Dr. Neur’s behavior in some ways. Despite all the matters going on with him, there was not flexibility for others staff members to use the OR. Another social factor that influence Dr. Neuer’ behavior might be his knowledge on how the organization does not have a clear understanding on what “constitutes adequate patient information to post a surgical case.” 3. What are the three potential obstacles to changing Dr. Neuer’s behavior? Should action (s) be taken against Dr. Neuer? The first and most important obstacle in this case is the lack of organizational skill from the managers and supervisors in charge of the OR. First of all when management an organization there should be a clear understanding on what and how services are practice or delivery. Therefore, not being able to identify the rules established for the department would constitute a barrier to change Dr. Neur’s behavior. Using imaginary patients could be another problem to change Dr. Neur’s behavior because it is hard to identify whether he is lying or not. Another potential factor that can be identified in this case is the lack of human and conceptual skills from Dr. Neur’s that disallow him to care for the organization’s goal. Actions must be taken against Dr. Neur. To start with, if nothing is done regarding this matter, the organization is not going to be able to success at longer term; since both production and finance are affected. 4. What are some ways that block time can be allocated to ensure the OR is used as efficiently as possible? Who should be in charge of this process? How can the process prevent ghost posting? One way that should improve the block time allocation is set up a carefully plan from top managers that would allow them to deliver and revise all the activities that each surgeon performs. In addition, having a clear understanding on what “constitutes adequate patient information” also will be an excellent tool that wou ...

1. Case 31
Ghost Posting in the OR
Discussion Question
1. What are the main facts of this case?
The main facts in this case show that a register nurse in the OR
discovered how Dr. Neuer’s is using techniques that are so
detrimental for the hospital just because he wants to protect his
block time. In addition, others surgeons who are part of the
organization have noted that although the OR is usually empty,
they have to go to others institutions to perform their surgeries.
Furthermore, Dr. Neuer uses imaginary patients to fill in the
time and availability for the schedule days in which he has to
post certain surgical cases. The RN communicates all this
matter to the administrator in charge of the OR. After further
investigations, it is concluded that Dr. Neuer does not want
anybody to know how is performing his job with inefficiency.
While Dr. Neuer continues doing this practice, the hospital will
be financially affected.
2. Which theory or theories do you believe best explain Dr.
Neuer’s behavior?
Bureaucratic theory can be used to describe Dr. Neur’s behavior
in some ways. Despite all the matters going on with him, there
was not flexibility for others staff members to use the OR.
Another social factor that influence Dr. Neuer’ behavior might
be his knowledge on how the organization does not have a clear
understanding on what “constitutes adequate patient information
to post a surgical case.”
3. What are the three potential obstacles to changing Dr.
Neuer’s behavior? Should action (s) be taken against Dr. Neuer?
The first and most important obstacle in this case is the lack of
organizational skill from the managers and supervisors in
charge of the OR. First of all when management an organization
there should be a clear understanding on what and how services
are practice or delivery. Therefore, not being able to identify

2. the rules established for the department would constitute a
barrier to change Dr. Neur’s behavior.
Using imaginary patients could be another problem to change
Dr. Neur’s behavior because it is hard to identify whether he is
lying or not.
Another potential factor that can be identified in this case is the
lack of human and conceptual skills from Dr. Neur’s that
disallow him to care for the organization’s goal. Actions must
be taken against Dr. Neur. To start with, if nothing is done
regarding this matter, the organization is not going to be able to
success at longer term; since both production and finance are
affected.
4. What are some ways that block time can be allocated to
ensure the OR is used as efficiently as possible? Who should be
in charge of this process? How can the process prevent ghost
posting?
One way that should improve the block time allocation is set up
a carefully plan from top managers that would allow them to
deliver and revise all the activities that each surgeon performs.
In addition, having a clear understanding on what “constitutes
adequate patient information” also will be an excellent tool that
would allow the organization to achieve efficiency.
Furthermore, in this case there are other ways that would allow
block time to be allocated in a proper manner to ensure that the
OR is used effectively. For example, instead of leading Dr.
Neuer’s to use the OR by himself; make him to practice with a
group of surgeons. That way he is not going to be able to lie
because others doctors would see who is there in reality. It can
be stated that the person who should be in charge of this
process, is the individual who deals with posting notices in
communication with the top supervisor from that specific
department.
5. What steps can you take to ensure against this practice in the
future? Provide your reflections and personal opinions as well
as your recommendations for what could have done differently
in this case.

3. One of the most important steps to follow in any organization is
to have effective managers, who ensure that each staff member
understands the organization mission and vision. When
managers dot no set up clear rules, usually employees take
advantage from that. To confirm that these types of practice do
not happenin the future it is better to monitor and track so often
the surgeon’s activities in the OR. Putting priority on those
surgeons whose block time utilization has decreased also will
help. Furthermore, establishing meetings between surgeons and
supervisors is another way to improve block time allocation.
Through these meetings they can communicate one another and
study the areas of development for each surgeon. One thing
that should be done differently in this case is to have the rules
clearly established so that any surgeon could not take advantage
from that.
Case Study write-up
Ghost Posting in the OR
1. Background Statement
The case of the “Ghost Posting in the OR” is a case that shows
the importance of having set up a plan in any organization.
Managers and supervisors should ensure that employees
understand the rules established in any department in a proper
manner. One of the major concerns in this case study is that the
person in charge of the OR does not show clear instructions on
“what constitutes adequate patient information to post a surgical
case.” this case shows that Dr. Nuer’s schedule utilization in the
OR has not been improving. Instead he was using imaginary
patients to fill in the block time. In addition, the day that the

4. surgeries were supposed to be performed he maintained either
that patients were not showing up or that they canceled at the
last minute. The register nurse has notes Dr. Neur’s behavior,
and therefore, she communicates this matter to the administrator
of the hospital. Investigation were made about what was going
on with Dr. Neuer’s and from that it was concluded that he just
used this technique to protect his block time.
2. Major Problems and Secondary Issues
One of the major problems in this case study is the ineffective
organization from top managers and supervisors to establish
understandable regulations for a certain department. Not being
able to identify the responsibilities of surgeons is a major
problem because when dealing with patient’s care it is so
important that both surgeons and administrator communicate,
plan and organize. In the majority of cases, major problems
leave to others issues that are so detrimental for the
organization. For example, in this case, Dr. Neur’s behavior
affects the organization financially. Also other surgeons may
feel uncomfortable because despite that the OR is empty; they
have to go to other hospital to perform their surgeries.
3. Your Role
As the administrator of the hospital, the first think do in order
to maintain efficiency is to let employees understand each rules
established in a given department. Make sure that they follow
the guidelines accordingly and examine task performed by
surgeons is another way to achieve productivity. Ensure that
employees would keep in mind what they have to do and how to
do it is going to be an important step in the organization plan.
4. Organizational Strengths and Weakness
One of the weaknesses that administrator in the hospital shows
in this case study is the unclear perception on how to post a
surgical case. In addition, one area of development that Dr.
Neur should work is to understand that an organization exist for
a matter and to serve certain communities or individuals. If a
surgeon does not improve performance, his practice experience
would not be effective. This can leave to serious consequences

5. such as decline nonproductive operating room, unemployment,
and decrease on clients. Furthermore, not everything in this case
study can be seemed as wrong. Some strength can be identified
as well. For example, the attitude that the register nurse took
towards Dr. Neuer in which she communicate the administrator
of the hospital what was going on is an organizational strength.
5. Alternatives and Recommended
Solution
s
One alternative solution to address this matter is to organize
better how the rules are stablished in the OR department. By
doing this managers and supervisors should communicate and
try to figure out an effective planning to ensure that surgeons
are accomplishing their tasks. Communication from managers
and the person who is in charge of the posting play an important
role in this case study. Therefore, having knowledge and
accountability of surgeons activities would constitute another
alternative solution to improve performance. Finally, do not let
Dr. Neuer to work along in the OR. Instead allow him to work
among a group of surgeons who practice together.
6. Evaluation
When managers in an organization are not able to present their
rules clear, it is hard for them to get effective productivity.
Setting up guidelines among departments and employees as

6. well, would allow the business to flow effectively. In addition
effective communication between managers, supervisors, and
regular employees should be essential in a business, especially
when dealing with patient’s care. If proper services are not
rendered, not patients will be admitted into the hospital. If no
real patients got to the hospital, the organization would
eventually end up going out of business.
Case 45
Nurse Bullying: Unprofessional Conduct
Discussion Questions
1. What are the facts of this case?
Raymond, a nurse in the ICU hospital, has a strong efficiency to
perform his job and duties. Almost everybody notes his
outstanding performance. He receives accomplishment from a
lot doctors in the department and client as well. However some

7. of sis coworkers started criticizing him because they tough that
his confidentially is going beyond reality. Raymond wants to
build an excellent relationship with his coworkers. But they
were bullying behind him. The need from Raymond to be part of
his coworkers, allows him to make the mistake of telling them
some personal information that at the end harms his ethical
view by the whole department.
2. What is the nature of organizational behavior problem?
The nature of this case study shows that in many cases
employees get jealous from other employees. Raymond as a
nurse is a top performer who basically wants to get along with
all the staff in the ICU, especially the most popular nurses.
However, because bullying to Raymond was so strong, he was
not able to have a personal success at a longer term.
3. Which theory or theories do you believe best explain the
behaviors of Raymond’s coworkers?
Since Raymond has the capacity to perform both leadership and
management tasks as well; some coworkers may see him as a
threat for themselves. In addition, Social factors such as
Raymond’s selection from the nurse manager to be in charge of
the ICU may be considered as a social theory that describes
Raymond’s coworker behaviors. Using isolation or exclusion to
Raymond might allow the nurses to have better satisfaction
among them.
4. As the nurse leader, what interventions would be useful in

8. dealing with workplace bullying?
The first thing to considered as an intervention to fight against
bullying in the work place; is that when hiring new employees
managers should make sure that each individual is capable to
well deal and manage demographics variables. In many cases:
race, ethnicity, sex, work experience, and professional level
tremendously influence bullying among coworkers. In addition,
managers and supervisors always need to be on top of their
employees, making sure that a respectful work environment is
maintained around staff members.
Creating workshops or specialize programs that educate nurses
on how maintain and develop a positive attitude in the
workplace is another way that should work to fight against
bullying.
5. What types of workplace behaviors define bullying?
The first workplace behavior that defines bullying in this case
study is the way that Raymond’ coworkers criticizes him behind
his back. The unethical way on how the most popular nurses
presented Raymond’s email conversations to the whole staff in
the ICU is another behavior that defined bullying in the
workplace.
6. Have you ever experienced or observed workplace bullying?
Describe what happened and how is managed?
A lot of people either have experienced or observed bullying in
the workplace. I have my own personal experience. When I first

9. started working about five years ago I did speak English very
well. Since I had a heavy accent, two of my coworkers make fun
of me every time I spoke. After this happen over and over I
ended up isolating myself from them and my other coworkers as
well. For me this was not a good experience. I felt so depressed
and I did not want to talk with anybody. My fear that other
coworkers would do the same to me allowed me to quick the
job. I that time I did not know how to handle these type
situations. I was not able to find anybody who advised or help
me how to manage bullying in the workplace.
7. How does bullying impact workplace moral? Productivity?
Patient care? Can you think of other effects of bullying in the
workplace?
Workplace moral is influenced enormously by bullying. When
an employee is bulled, he or she might end up leaving the
organization because no one wants to be in a place where social
isolation, mistreatment, and personal attacks are consistent. All
these factors would allow either a department or employees to
have poor or low moral standards. Furthermore, decrease in
productivity is usually guaranteed in a department when
employees are bulled. For example: in this case study can be
inferred that the way that specializes nurses in the ICU
department acted to gain control or have dominion over
Raymond’s; allowed him to ended up decreasing his
productivity. Some of The factors can be considered

10. psychological and therefore can affect his efficiency in the
department. Besides all the issues mentioned before; another
detrimental effect that bullying lead in the workplace is the
ineffective quality on patient care. Nurses who are bulled can
become emotionally untestable. Also they can make errors when
admitting medication to patients.
8. How does leadership or management team contribute to
bullying?
Managers or leaders who do not influence and encourage their
staff to do get better, is a way of contributing with bullying in
the workplace. Sometimes some employees do not realize that
they are deteriorating another coworker with their comments or
critics. In addition, other factors that contribute to bullying
from managers and supervisors in the workplace are not
allowing everyone to participate in team conferences; also to
showing care about what they say.
9. What types of ethical issues are identified in this case study?
One of the major ethical issues identified in this case is the way
that Raymond’s coworkers embarrassed him in front of the
whole ICU department. Showing out the conversation
maintained between Raymond and the secret admirer, who was
one of the nurses who planned the prank, was morally wrong
from her. In addition, Raymond behaviors are considered
unethical in some occasions. As a professional the individual
always should maintain high standards in any organization. This

11. includes not sharing your personal live with a coworker just
because you want to get confidence from her.
10. What kind of financial impact do you think the behavior of
the nurses and their supervisor may have on the hospital?
Misbehavior from nurses and supervisors affect the finance of
the hospital enormously. The first issue to consider is the
decrease in productivity. When a staff member does not perform
the task properly, someone else may have to do it. In addition,
if nurses are distracted by some factors such as bullying, they
may not delivery an adequate quality care to patients. If this
happen the hospital would have a decrease of patients coming in
and therefore its finance would decline as well.
11. Provide your reflections and personal opinions as well as
your recommendations for addressing this problem.
Bullying has become a major problem in the workplace
nowadays. By examining this case study it is more than clear
that sometimes top performer employees make mistake due to
social isolation. It is sad to see that somebody who is capable to
influence, lead, and organized could not be able to gain
popularity in a specific department. When managing an
organization, administrators should always make sure that
employees are not perceived as overconfidence from others
coworkers. Also educate their staff members, establish rules or

12. regulations, and assign task to everybody despite their
popularity. All these decision making should be based on their
experience and knowledge about the subject. In addition,
dividing the tasks and responsibilities in a fear manner among
employees in a specific department would help to get better
outcome for the organization and employees as well.
Case Study write-up
Nurse Bullying: Unprofessional Conduct
1. Background Statement
This case study shows how bullying is affecting the workplace
enormously nowadays. This is a major concern that a large
number of Organizations such as hospitals deal with it. In this
case study Raymond, who is a nurse in the ICU department in a
hospital, is bulled by his coworkers. As it is stated in the case,

13. Raymond is a person who delivery woo quality services to his
patients and coworkers as well. In addition, he is well prepared
among the other nurse practitioners in the department. Raymond
possesses a strong leadership personality. He is always
answering questions, helping others, and taking excellent care
of the physician’s patients and their family as well. Raymond is
admired by the majority of people among his job including,
doctors, patients, and other staff members. He is always trying
to build an excellent relationship with popular nurses, who are
his coworkers. However, despite all his excellent performance,
he is not able to gain popularity from the most them. Although
he is a top performer, his behavior leads to be interpreted as
“overconfident and conceited.” Therefore, some of his
coworkers commit immoral and unethical issues with him that
enable him to end up socially exposed in front of the whole
department.
2. Major Problems and Secondary Issues
One of the major problems in this case study is how some of
Raymond coworkers influenced him to end up breaking his
moral ethics. Bullying in the workplace is major a problem that
in the majority of the cases lead to others issues that affect any
organization at either short or longer term. In addition, as
manager of any organization, the individual should take into
account that when tasks and responsibilities are divided, there is
usually a better outcome. It can be argued that this could

14. influence popular nurses to misbehave against Raymond; since
the nurse managers usually “put him in charge of the ICU
department. A secondary issue in this case study is the way that
Raymond acts in order to gain confidence from his coworkers.
Whenever a person is working in any department, he or she
should maintain personal business a part. The reason for this is
that never is known who can damage your excellent record just
because they feel jealous.
3. Your Role
As the administrator of this hospital, the manager’s role will be
to establish meting or workshops more usually to educate
employees on how to deal with the bullying issue. The next step
to follow would be to establish clear guidelines that monitor
and guide each employee through in a daily basis. Everybody
must obey and follow the directions established under each
department. Otherwise they would face serious consequences
such as fines, lawsuits, and unemployment. Finally, work
assignments are going to be dived with equality, responsibility,
and proper manner in which the majority of the staff members
feel confidence and happy as well.
4. Organizational Strengths and Weakness
One weakness from the organization view is the way that the
nurse manager monitors his employees. It is true that bullying
occurs when the bosses are not presented in the majority of the
cases. However, as an administrator of an organization like a

15. hospital, being on top of staff behaviors should be one of the
main subjects that mangers address. In addition, this case study
also shows its strengths in many parts. For example: having a
nurse who possesses the majority of quality to deliver excellent
patient’s care is awesome; since this would allow the hospital to
accomplish its short and long term, to become successful.
5. Alternatives and Recommended