Bottom Line Strategy To Comply with the 2019 Magnet® Requirements Regarding Workplace Violence

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Businessperson's Hand Holding Horseshoe Magnet Attracting LeadsNumerous studies show that Magnet® designated organizations have higher nurse satisfaction, less turnover, and they experience higher revenues, which offsets the high cost for achieving it. When an organization achieves Magnet® status, the public (which includes nurses) assumes the organization is committed to nursing excellence.

Only 8.8% of U.S. hospitals (data from 2015) have received the distinguished Magnet® recognition, and many more are on the journey. Organizations that achieve this gold standard attract the best nurses and patients who are more savvy now when it comes to “shopping” for healthcare.

If all of this is true, then it would make sense to assume that bullying and incivility can’t exist in a Magnet® designated hospital…right?

False Assumption

Of the nurses who reach out to me for help, many are currently working in a Magnet® recognized hospital.

Believing that achieving Magnet® status means that bullying and incivility don’t exist is a false and costly assumption. Disruptive behaviors occur just as frequently in Magnet® hospitals as they do in non-Magnet hospitals. However, the difference is that the Magnet® hospitals are now required to do something about it.

Taking Action Against Bullying, Incivility, and Workplace Violence

As bullying, incivility, and workplace violence continue to rise in healthcare, organizations such at The American Nurses Credentialing Center (ANCC) and The Joint Commission are recognizing the negative impact these behaviors have on individuals, the nursing profession, and ultimately, the patients we serve.

Violence in the workplace is a national issue and healthcare organizations are not immune.  Actually, we are seeing more incidents of bullying, incivility, and workplace violence in healthcare!  To address these issues, in April of 2018, The Joint Commission released Sentinel Event Alert #59 with information regarding disruptive behaviors in healthcare and the recommendations for organizations to take action.

In similar fashion, in October 2017, the ANCC released the 2019 Magnet Application Manual, their 12th in 27 years. In this revised manual, they included specific requirements to address disruptive behaviors. Specifically, EP15EO requires that organizations recognize, address and improve upon incidences of nurse bullying, incivility, and violence.

The 2019 requirements have just raised the bar for organizations to achieve Magnet® status.

Compliance with EP15EO involves the following…

  1. Establish baseline and ongoing data regarding incidents of disruptive behaviors.

To implement systems, processes, and structures for ongoing identification and elimination of disruptive behaviors, the issues need to be fully understood. Therefore, the hospital must collect relevant data that identifies a problem followed by a plan for improvement. Although there are many common employee surveys, it’s rare to find an organization that surveys employees specifically related to exposure to bullying, incivility, or violence.

At the Healthy Workforce Institute, we developed a survey to assess the degree of witnessed and experienced incidence of disruptive behaviors. When conducting a deep dive assessment, we utilize a blend of stakeholder focus groups, interviews, surveys, and document reviews to collect relevant data specific to disruptive behaviors. After the initial data is collected and analyzed, specific interventions are implemented to address the issues identified by the data collection. Employees are resurveyed every 6 months to determine improvements.

Click here to access the Healthy Workforce Institute’s Disruptive Behavior Baseline Assessment.

Bottom line is that organizations must collect data with regards to any type of violence, be it physical or psychological (bullying and incivility) initially and ongoing.

  1. Provide an example, with supportive evidence, of an improved workplace safety outcome for nurses specific to physical and psychological violence and workplace incivility.

One of my clients, who is a Chief Nursing Officer, said in response to someone’s question, “How are we measuring our improvements” said, “For me it’s not about the numbers. I know this place [the hospital] is different.  We’ve changed the culture. You can feel it when you walk onto the nursing departments. I don’t need a number for me to know this.”

Measuring human behavior and changes to behavior can be challenging at best. However, as with any interventions, it’s important to capture outcomes to determine effectiveness. Supportive evidence should include both quantitative data such as turnover, survey results, retention data, number of complaints related to disruptive behaviors, etc.  Qualitative data could include observations, interviews with employees, and success stories.

Bottom line is that organizations need to show evidence that the interventions they’re adopting are reducing incidents of disruptive behaviors.

  1. Produce and implement an organizational safety strategy.

Many organizations take a reactive approach to bullying, incivility, and workplace violence. When an incident occurs, they decide to do something about it. However, what EP15EO is asking is that organizations proactively identify and implement a strategy to keep their nurses safe.  How do you define bullying, incivility, and are you training and educating your nurses on the differences? What is the reporting mechanism, especially for any type of physical violence? Do your nurses know how to respond?

Bottom line is that organizations need to develop a safety strategy and then intertwine it with the organization’s strategic goals. The safety strategy can’t just be words on a piece of paper – employees need to see the safety strategy as a living and breathing strategy.

Even if the ANCC and TJC didn’t add safety requirements into their standards, all healthcare organizations should be taking a proactive approach to keeping their employees physically and psychologically safe. Disruptive behaviors happen because they can. It takes dedicated leaders and employees to step up and DO something about it.

Final bottom line – Addressing and reducing incidents of bullying, incivility, and workplace violence should be a requirement whether you’re a Magnet® designated hospital, on the journey, or it’s not even on your radar. Not only is it the right thing to do for the health of your organization but it’s also the right thing to do for your nurses and the patients they serve.

To find out how The Healthy Workforce Institute can help your organization reduce incidents of bullying, incivility, and workplace violence, so that you can meet the 2019 Magnet® requirements, contact us at and visit us at

Renee Thompson


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