Brian S.

Chronic obstructive pulmonary disease (COPD) affects a diverse patient population, each with their own set of preferences and needs.1 Nurse Practitioner Dana Hickman, MSN, discusses her experiences prescribing a treatment option for COPD, and speaks to the importance of individualizing treatment. LONHALA® MAGNAIR® (glycopyrrolate) is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. LONHALA MAGNAIR is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients. Please see Important Safety Information featured in the video above and full Prescribing Information and Patient Information for LONHALA MAGNAIR at www.sunovionprofile.com/lonhala-magnair. GOLD does not endorse any specific treatments. GOLD = Global Initiative for Chronic Obstructive Lung Disease. Reference: 1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020:1-125.

Earlier this month, The National Nurses United held a day of action to demand that hospitals and elected officials better protect them with Personal Protection Equipment (PPE) and a safe number of patients during the COVID-19 pandemic. Nurses in sixteen states including California, Florida, Georgia, Illinois, North Carolina, New York, Texas, and Washington, D.C. were involved. For a virus which has been within the borders of the United States since January, how is PPE availability even an issue in August? After over seven months, any rational person would expect that the companies who routinely produce these items – gowns, N95 masks, goggles, safety shields, and more – would have had plenty of time to ramp up production both in the United States and globally to provide the life-saving equipment for healthcare workers. The sad reality, though, is that this is just one piece of the response to this pandemic that has been severely botched. With each state and sometimes each healthcare company or even each facility being left to fend for themselves early on, procurement of PPE became a money game. With states bidding against each other to obtain oftentimes scarce PPE, it became a case of the haves versus have-nots. In a country where profits reign supreme, the COVID-19 pandemic became just another way for companies to profit on the suffering and death of others. It’s shameful but sadly all too real. While many will recall images of nurses in New York City from March and April donning garbage bags in lieu of proper disposable gowns, maybe things have changed. Maybe. What about the Defense Production Act? The very act to be used during times of national crisis which was supposed to spur companies to ramp up emergency production of the very equipment necessary to protect nurses in COVID wards appears to have yielded mixed results, at best. According to a July 10th press release from the Department of Defense, $84.4 million was appropriated for COVID-19 but appears to have gone for basically anything but PPE for healthcare workers. What is the Defense Production Act? The Defense Production Act is the primary source of presidential authorities to expedite and expand the supply of materials and services from the U.S. industrial base needed to promote the national defense. DPA authorities are available to support: emergency preparedness activities conducted pursuant to title VI of the Stafford Act; protection or restoration of critical infrastructure; and efforts to prevent, reduce vulnerability to, minimize damage from, and recover from acts of terrorism within the United States. DPA authorities may be used to: Require acceptance and preferential performance of contracts and orders under DPA Title I. (See Federal Priorities and Allocations System (FPAS).) Provide financial incentives and assistance (under DPA Title III) for U.S. industry to expand productive capacity and supply needed for national defense purposes; Provide antitrust protection (through DPA voluntary agreements in DPA Title VII) for businesses to cooperate in planning and operations for national defense purposes, including homeland security. AirMap, located in Santa Monica, California, received $3.3M to aid product development and engineering support for integration of sUAS mission planning, post-mission analysis, and unmanned traffic management software. ModalAI, located in San Diego, California, received $3M to develop their next generation U.S.-made flight controller that will enable advanced autonomy including GPS-denied navigation, and all-environment obstacle avoidance. Skydio, located in Redwood City, California, received $4M to improve the flight controller hardware/software and data link for their sUAS so that highly capable components can be purchased and used across U.S. Government unmanned systems. Graffiti Enterprises, located in Somerset, New Jersey, received $1.5M to modify their commercial data link for DoD’s sUAS use including operation in restricted frequency bands, reduction in the size, weight, and power of the hardware, and software developments to improve security and resiliency of their data link. Obsidian Sensors, located in San Diego, California, received $1.6M to build a low-cost, dual thermal sUAS camera that can be mounted onto a stabilization gimbal and then integrated and flown on small, packable, ISR systems. (source) It doesn’t end there, though. An additional $15 million was awarded to LeoLabs to strengthen the country’s Domestic Space Industrial Base. $56 million more went to ArcelorMittal, Inc. to “sustain critical domestic industrial base shipbuilding capability and capacity”. While this example of where $84.4 million of Title III COVID-19 funds went is only a portion of Defense Production Act spending somehow tied to the pandemic response, it is part of the puzzle of why nurses are still protesting over a lack of PPE. Want more details? Download allnurses Magazine What has been approved so far? While the above example portrays an excellent example of rather questionable spending tied to the Defense Production Act under the guise of COVID-19 response, hundreds of millions of dollars have been handed out in the name of COVID-19 PPE production. Or has it? N95 Masks On April 13th it was announced that a $15 million contract for 60 N95 Critical Care Decontamination Units was awarded. These units are touted as having the capacity to decontaminate 80,000 N95 masks per day. These reportedly allow N95 masks to be reused up to 20 times. This would allow for decontamination of up to 34 million N95 masks per week. Only weeks later, the Battelle Critical Care Decontamination System came under fire. “After 20 cycles, the company’s testing showed, the masks’ straps fragmented during stretching, which “may potentially impact the fit or comfort of the respirator exposed to the (vaporized hydrogen peroxide) cycles. While NBC News questioned the size of this particular federal contract, they found “That contract ballooned from a total of $60 million for 60 systems on April 3 to up to $413 million a few days later, according to the network.” To their credit, Battelle had deployed 50 of the 60 promised units by early June. On April 21, $133 million was awarded to 3M, O&M Halyard, and Honeywell to increase N95 production by over 39 million units over the course of 90 days. That 90 day window would end on or around August 21. (via) May 6th saw a second contract awarded to 3M for production of N95 masks – this time for $126 million. The contract stated that 3M would manufacture an additional 26 million N95 masks per month beginning in October. This new contract was expected to increase N95 respirator production by at least 312 million units annually within the next twelve months. (via) Testing Swabs April 29th saw the announcement that $75.5 million would be invested to increase swab production to 20 million per month starting in May. Puritan Medical Products in Maine stated that they would establish a new manufacturing facility to produce the swabs used for Coronavirus testing. The company also stated that they would add 150 employees in May to meet the stated production capacity which would soon ramp up to 40 million swabs per month. This ramping-up phase in May, though, is claimed by many to have been too late. For a virus that was already spreading in February, a two-plus month delay in something as seemingly basic as swab production is just one in a long list of items that contributed to the spread of COVID-19. According to many of the nation’s governors, the federal government’s delay caused a shortage of tests early on which hampered initial phases of the pandemic response. (via) Prefilled Syringes On May 12th, ApiJect Systems America was awarded a $138 million contract to produce over 100 million Blow-Fill-Seal aseptic plastic injection devices. These would be produced for use with the yet-to-be-developed COVID-19 vaccine. An ultimate production goal of over 500 million profiled syringes was expected in 2021. For a company whose CEO says “The fact of this matter is, it would be crazy for people to just rely on us. I would be the first to say it, we should be America’s backup at this point, but probably not its primary,” (via) that should certainly raise some questions about the award of this no-bid contract. Add in the fact that the contract could grow by an additional $456 million to bring several new factories online, that is a substantial sum for a company who has, to date, only produced 1,000 prototypes. Oh, and there’s the small detail that ApiJect doesn’t have a manufacturing facility yet. PPE for Nursing Homes Good news for nursing homes across the country arrived on May 13th as Federal Resources Supply Company was awarded a $134 million contract. Federal Resources Supply Company would be supplying PPE kits including 1.2 million goggles, 64.4 million pairs of gloves, 12.8 million gowns, and 13.8 million masks. (via) There were almost immediately problems with the PPE distributed by Federal Resources Supply Company. Many of the masks which were delivered appeared to have been made of an underwear material – even arriving sometimes in packaging donning the Hanes brand name. Other surgical masks were outfitted with flimsy paper loops, leaving caregivers at risk due to the ill fit. Many gowns that arrived were compared with trash bags and routinely lacked arm holes. Many of the gloves which did arrive in the first wave of distributions were essentially useless – size extra-small – entirely too small for even the smallest healthcare workers. When complaints were made, the responses from FEMA officials ranged from “It was one of those things, I’ll be honest, that just slipped through the cracks” to “[you] just don’t know how to use them.” The examples of both good and bad outcomes from the Defense Production Act keep coming and are too numerous to detail. Some of the most angering and wasteful are the examples of money being explained away as for the nation’s COVID-19 response being handed out to companies for defense and military projects – specifically those detailed to benefit the Navy, Coast Guard, various aerospace systems, ship manufacturing and more. For a federal government whose national response to what rapidly became a global pandemic was massively delayed, some of these expenditures are simply disappointing. The amount of money being spent on items and given to companies who lack experience in anything remotely related to what is clearly a medical crisis is appalling. This, however, is what happens when a nation’s priorities move from caring about its citizens to profits for companies. For a complete rundown of Defense Production Act contracts, download the Fall 2020 issue of allnurses Magazine for FREE!

With schools across the country already open or opening soon, there has been plenty of hand-wringing regarding what is safest for students. Educators, school leadership, and school boards are all weighing in on what they feel will work best in the middle of a global pandemic. What many forget, though, is that school districts have medical professionals on staff. Yes, the often overlooked school nurses. I recently took some time to visit in a socially distanced format with a school nurse who was willing to give us some insights and advice for the 2020-21 school year. In my conversation with Emme, she shared her past challenges and future concerns in the midst of a pandemic. Here’s what she had to say... Let’s get started getting to know you, Emme. Tell our readers a bit about yourself, how long you have been a nurse, why you chose to become a school nurse, and how many students are in your building or buildings? Download allnurses Magazine EMME: Sounds good! I have been an RN for about 8 years now. I started out as a medical assistant in pediatrics for about 10 years then once I was an RN I worked in emergency trauma at a level 2 trauma center. I also changed to labor & delivery nursing for about two years overlapping the school nursing. I have been a school nurse for going into my 4th year now - I was attracted to the day shift hours, the pediatric angle and found that it was definitely my calling as a nurse! I am currently working for a large district with 214 schools and around 300 school nurses. I work in a K-5 elementary with approximately 600 kids. allnurses: With four years of experience as a school nurse and eight years as a RN, I’m sure that you have experienced plenty. How did the closure of schools earlier this year affect both you and the students you interact with on a daily basis? E: Interestingly, my school had a rough year this past year - we had construction in the building to update classrooms and asbestos turned up. My school ended up closed for two weeks at the end of February and then we were relocated to another building for a few days before we were allowed back in. The kids missed almost 2 full weeks of instruction, then we were back to normal for about 2 weeks then we closed again. While we were off school before they made the decision to close indefinitely I had no interaction with the students and no instructions. I felt terrible about that and kind of useless so I went ahead and made my own Google Classroom to communicate and began using ClassDojo to communicate with the parents. I started making videos (only made two) to share with them about safety, such as how to wear masks and a little germs experiment, just so they could see my face. The big kids seemed to like it! I posted to my Google Classroom daily with things like yoga classes From Youtube, meditation for kids from Youtube just to help them take a breather and relax, and I found a great fitness coach who posted PE class every day! Plus I found lots of health education stuff online that I posted. None of the K-2 kids logged on to my stuff but the 3-5 kids did! I also had “office hours” that the students and parents could contact me if they needed to but no one did. During that time I also attempted to contact all my parents of kids with health issues or any concerns on my part to check in and make sure they were OK and didn’t have any questions. Most I was not able to get in contact with, sadly. AN: WOW! That definitely sounds like you and your school had more than their fair share of challenges even before COVID-19 struck. How have you, as a school nurse, been preparing for the upcoming school year? If your school district has announced adjustments for the 2020-21 school year, what type of adjustments have been made? E: At the moment my preparation has been mostly educating myself and trying to keep up with the changing rules and news, trying to organize and plan out how I will change my practice for the coming year, and collect questions that I have for my supervisors. I’ve attended several webinars, and started collecting or making flow sheets and info sheets to share with staff to keep everyone informed. We are still awaiting directives from the district as far as in person vs virtual opening, and awaiting a zoom meeting with the nursing supervisors to go over details and further info. Unfortunately at this point we are getting very close to starting the new year and very few decisions have been made (or at least communicated with the nurses and staff). Presently, the plan on the table is a hybrid 2 days in school and 3 days virtual divided into two groups. This plan is being contested by the union and the parents and staff network and awaiting a second board meeting to approve or decline it. Other adjustments include masks for everyone all day in school, desks 6 feet apart, lunches in the classrooms, ramped up cleaning protocols, and temp checks at home before coming to school - no temps at the door of the building as it isn’t a feasible procedure or a realistic measure of COVID specifically. Specifics of all of these things are unknown at this time to me. AN: It seems that many of the decisions regarding in-person vs. virtual or distance learning or a hybrid model of the two are still very much up in the air in many school districts. Have you or your fellow school nurses been attempting to procure PPE? If so, what types of PPE are you and your peers planning on using, and is it being provided by the school district or by other means? E: PPE is to be provided by the district at this time. I am providing my own cloth face masks, face shields, and N95 masks just to be safe and ensure that I have it, and also I will wear a lab coat over scrubs. The district has stated that they will provide disposable face masks and face shields for the students and staff or they are welcome to provide their own if desired. As far as other PPE like disposable gowns or N95’s for mon medical staff I am not sure yet. I will have to order my gloves and other supplies not provided for me once we start back to the buildings and have our budgets prepared to order supplies. AN: With PPE seemingly in place for the upcoming school year, what are your areas of concern both for school nurses, other school staff, and students? E: Oh boy, that’s a big one. I’ll try to narrow it down. 1. Special needs kids, autism support kids, and medically disabled kids will have a very hard time if we reopen schools but also if we don’t reopen. If we do reopen these children are mostly unable to manage wearing masks, distancing, or even basic hygiene this putting staff and each other at risk. 2. Many of our buildings are not physically upgraded enough to manage the requirements for adequate ventilation, cleaning, or distancing. Mine personally has no air conditioning and many windows that do not open. We are supposed to have a separate isolation area for students and staff but mine and many others do not have an adequate room available. Mine and many others are currently under construction for upgrades but not the ones needed. 3. Unfortunately, we have many families that will not comply with the rules put forth such as checking temperatures at home, keeping kids at home if they are sick or honestly reporting. School nurses everywhere share the issue of parents who don’t answer the phone when you call them or not picking the kids up or giving them Motrin and sending them to school. 4. On the flip side, if we don’t open and do all virtual we have the issue of special needs students suffering from not having face to face education, students who may come from abusive or neglectful homes not being seen or helped, many many without adequate internet to do virtual learning, and many parents that have to go to work and can’t leave little ones home. Many children will suffer. 5. There is plenty of staff (and students and families) who are older and more at risk or have family members who have risk factors. Going into the buildings for them is potentially a death sentence for their families. 6. We nurses specifically are all quite anxious as we are still waiting for directives from our supervisors. It seems like it’s going to be a very big job and we are not ready! Plus many are also at risk for illness or death as well if they have to go into the buildings and are exposed. AN: Do you have any words of advice for school nurses, parents, or school-age children who may be reading this? E: For the nurses: be flexible, be patient, and do the best you can in the situation we are stuck in. It’s confusing and different but we’ve been through worse (if you got through nursing school you’ll get through this too!) For the parents: we are here for you and your families. No matter how this craziness plays out the primary goal is safety for your kids and getting them the safest education possible. Don’t be afraid to ask for help or ask questions. For the students: do the work!! If you’re all virtual or hybrid or even going back full time you still have to put in the work. Listen to the rules, wear your masks, wash your hands, pay attention to the distancing rules and things will be normal eventually. This is all temporary. If you feel anxious or worried or feel like you need to reach out then don’t be afraid to say something.

Four candidates. One presidential election.Being an informed voter on multiple issues can help to make your voting decision easier. We have compiled each 2020 presidential candidate’s position on multiple issues concerning American voters during this year’s election. The candidates featured on this page are the presumptive and confirmed presidential nominees from the Republican, Democratic, Libertarian, and Green parties. These statements and stances were compiled from each candidate’s official campaign website, editorials, speeches, and interviews. What are your thoughts on the stances of Donald J. Trump, Joe Biden, Jo Jorgensen, and Howie Hawkins? Share your comments below!

The latest round of apparent mis-steps by police in Minneapolis – this time by the Minnesota State Highway Patrol – was the arrest of a CNN crew. As they broadcasted early this morning from outside the Minneapolis 3rd Police Precinct, officers arrested the reporter and crew. The reporter identified himself, was calm, and asked where to move. The reporter and crew were released but this certainly doesn't reflect well on the police handling the riots in Minneapolis. One last detail is that the reporter was a black man. All of this was broadcast live on national TV.

Thanks to everyone who has submitted an entry for our Student Toon Caption Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our Nurses Week 2020 Meme contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our "Send a Message to the World" Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our "Nurse Heroes Caption" Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our "Funny Things Patients Say" Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our "Share Your Covid-19 Stories" Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our "What in the World" Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Thanks to everyone who has submitted an entry for our Toon Caption Nurses Week 2020 contest. The winner has been selected and notified via private message so check your inbox to see if you've won!

Here's a great short video from Instagram to #giveanurseahug

Prolific author and allnurses.com columnist Nurse Beth (Beth Hawkes) is back with another amazing book jam-packed with great advice and insight. As a way to give back to nurses, Beth Hawkes is giving away EIGHT COPIES of her newest work – 'First Year Nurse' With advice on working with doctors, prioritizing care, and time management; this book is a must-have for nurses who are beginning their careers! 'First Year Nurse' isn't available for purchase until May 19th but as part of National Nurses Week, you can win a copy before you can buy it! Click below to complete the form and you're entered to win. Be sure to enter each day to increase your chances of winning. We are giving away one copy for each day of National Nurses Week and another copy exclusively for Nursing Students!