National Nurses Week is a time of fun, festivities, celebrations and socialization. However, this past week's news of tragic, violent situations surrounding nurses and healthcare workers brings much-needed attention to the dirty little secret of violence against healthcare workers.

On May 12, Thomas Hartless entered Pine Kirk Care Center in Kirkersville, Ohio, and killed his previous girlfriend, nurse Marlina Medrano, along with nurse's aide Cindy Krantz and Kirkersville Police Chief Steven Eric Disario.

The following day, on May 13, inmate Tywon Salters took two nurses hostage as a patient at Delnor Hospital in Geneva, Ilinois. Salters had been hospitalized for approximately five days after eating plastic off a sandal from his jail uniform. Doctors had to surgically remove the plastic from his stomach.

While recovering, he apparently stole the handgun from the correction officer guarding him and took one of the floor nurses hostage. According to the sherriff's office, he released that nurse and took a second nurse hostage where he apparently went down to the emergency department and barricaded himself in a treatment room.

The three-hour stand off came to an end after failed negotiations, and the SWAT team entered the room and fatally shot Salters.

When the general public thinks of violence against healthcare providers, most immediately think of the emergency department or trauma centers. Curiously, both incidents occurred in what would be perceived as low-threat areas in healthcare — a nursing home and a typical medical surgical floor of a hospital.

These events clearly demonstrate that despite efforts, healthcare continues to be plagued with violence against workers.

According to a recent report by the International Association for Healthcare Security and Safety, Workplace Violence Type 2 (violence directed at employees) accounted for 85 percent of all aggravated assaults and 91 percent of all assaults in the 222 U.S. hospital respondents.

Of more interest, the respondents were asked whether their state had an "Assault on Healthcare Worker" law. For those that did, only 15 percent of these incidents resulted in a charge in 2016. This startlingly small number evokes questions of possible internal policies that may discourage staff members form pressing charges and/or the justice system's lack of commitment to prosecute situations that are deemed "part of the job."

Although all 50 states have some type of criminal law protecting healthcare providers, most are lacking in full coverage of all workers. While many laws are aimed at emergency medical technicians, few provide protection or consequences for those in hospitals, clinics or home health.

However, having legislation in place is usually too little, too late, as we saw in recent incidents.

What most experts agree is lacking is recognition and prevention training for healthcare workers in the hopes of preventing violent incidents. Multiple resources are available through the National Institute for Occupational Safety and Health, however, there are no mandates for training, except in special circumstances in few states.

Healthcare facilities are left to monitor themselves. It would seem it would be in the facilities' best interest to try to prevent harm considering a 2014 study in the Journal of Emergency Nursing noted that the "annual workplace violence charges for the 2.1 percent of nurses reporting injuries were $94,156 ($78,924 for treatment and $15,232 for indemnity."

So as another National Nurses Week came to a close, it became clear that there is more work to be done.

Healthcare workers need to be proactive and educate themselves on identifying those patients at risk for becoming violent. Healthcare workers also need to continue to advocate for more workplace training, because I am sure none of these nurses ever thought it would happen to them.