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Working While the World Sleeps

For many nurses, paramedics, and factory workers, the workday begins when everyone else is going to bed. The National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), defines shift work as any schedule outside the hours of 7 a.m. to 6 p.m. Night and rotating shifts keep hospitals and emergency services running around the clock, but they require people to be awake at the very hours when the body expects to sleep.

The reason lies in the body's internal clock. According to the National Institutes of Health, circadian rhythms include physical, mental, and behavioral changes the body goes through over a 24-hour cycle. A group of nerve cells in the brain, called the suprachiasmatic nucleus, acts as a master clock. Light and darkness have the strongest influence on these rhythms. In the evening, as light fades, the brain makes more melatonin, a hormone that causes sleepiness. A worker who comes home at sunrise is trying to fall asleep just as the morning light is reaching the eyes.

The result is often too little sleep. The CDC recommends that adults aged 18 to 60 get 7 or more hours of sleep each night, yet NIOSH reports that night shift nurses report inadequate sleep 60 percent more often than day shift nurses. Over time, shift work and the fatigue it brings have been linked to higher risks of obesity, diabetes, heart disease, and depression. NIOSH also warns that fatigue from too little sleep can impair thinking and memory and is linked to errors in patient care and to vehicle crashes.

None of this means that night work must be harmful. NIOSH notes that many of these risks can be reduced by correcting disruptions to sleep and circadian rhythms. Workers can protect their daytime sleep by going to bed at the same time each day, keeping the bedroom quiet and cool, turning off phones and other screens at least 30 minutes before bed, and avoiding caffeine in the hours before sleep. Employers play a part, too: NIOSH points out that long work hours leave workers less time to recover.

In my view, hospitals that schedule nurses for back-to-back night shifts without adequate rest are making a serious mistake. A tired caregiver is not a heroic caregiver. Protecting sleep should be treated as part of patient safety, not as a personal luxury.

Working While the World Sleeps

For many nurses, paramedics, and factory workers, the workday begins when everyone else is going to bed. The National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), defines shift work as any schedule outside the hours of 7 a.m. to 6 p.m. Night and rotating shifts keep hospitals and emergency services running around the clock, but they require people to be awake at the very hours when the body expects to sleep.

The reason lies in the body's internal clock. According to the National Institutes of Health, circadian rhythms include physical, mental, and behavioral changes the body goes through over a 24-hour cycle. A group of nerve cells in the brain, called the suprachiasmatic nucleus, acts as a master clock. Light and darkness have the strongest influence on these rhythms. In the evening, as light fades, the brain makes more melatonin, a hormone that causes sleepiness. A worker who comes home at sunrise is trying to fall asleep just as the morning light is reaching the eyes.

The result is often too little sleep. The CDC recommends that adults aged 18 to 60 get 7 or more hours of sleep each night, yet NIOSH reports that night shift nurses report inadequate sleep 60 percent more often than day shift nurses. Over time, shift work and the fatigue it brings have been linked to higher risks of obesity, diabetes, heart disease, and depression. NIOSH also warns that fatigue from too little sleep can impair thinking and memory and is linked to errors in patient care and to vehicle crashes.

None of this means that night work must be harmful. NIOSH notes that many of these risks can be reduced by correcting disruptions to sleep and circadian rhythms. Workers can protect their daytime sleep by going to bed at the same time each day, keeping the bedroom quiet and cool, turning off phones and other screens at least 30 minutes before bed, and avoiding caffeine in the hours before sleep. Employers play a part, too: NIOSH points out that long work hours leave workers less time to recover.

In my view, hospitals that schedule nurses for back-to-back night shifts without adequate rest are making a serious mistake. A tired caregiver is not a heroic caregiver. Protecting sleep should be treated as part of patient safety, not as a personal luxury.

Working While the World Sleeps

For many nurses, paramedics, and factory workers, the workday begins when everyone else is going to bed. The National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), defines shift work as any schedule outside the hours of 7 a.m. to 6 p.m. Night and rotating shifts keep hospitals and emergency services running around the clock, but they require people to be awake at the very hours when the body expects to sleep.

The reason lies in the body's internal clock. According to the National Institutes of Health, circadian rhythms include physical, mental, and behavioral changes the body goes through over a 24-hour cycle. A group of nerve cells in the brain, called the suprachiasmatic nucleus, acts as a master clock. Light and darkness have the strongest influence on these rhythms. In the evening, as light fades, the brain makes more melatonin, a hormone that causes sleepiness. A worker who comes home at sunrise is trying to fall asleep just as the morning light is reaching the eyes.

The result is often too little sleep. The CDC recommends that adults aged 18 to 60 get 7 or more hours of sleep each night, yet NIOSH reports that night shift nurses report inadequate sleep 60 percent more often than day shift nurses. Over time, shift work and the fatigue it brings have been linked to higher risks of obesity, diabetes, heart disease, and depression. NIOSH also warns that fatigue from too little sleep can impair thinking and memory and is linked to errors in patient care and to vehicle crashes.

None of this means that night work must be harmful. NIOSH notes that many of these risks can be reduced by correcting disruptions to sleep and circadian rhythms. Workers can protect their daytime sleep by going to bed at the same time each day, keeping the bedroom quiet and cool, turning off phones and other screens at least 30 minutes before bed, and avoiding caffeine in the hours before sleep. Employers play a part, too: NIOSH points out that long work hours leave workers less time to recover.

In my view, hospitals that schedule nurses for back-to-back night shifts without adequate rest are making a serious mistake. A tired caregiver is not a heroic caregiver. Protecting sleep should be treated as part of patient safety, not as a personal luxury.

How a New Vaccine Earns Its Place

Before a vaccine is offered at a pharmacy or clinic, it travels a long road. The CDC describes vaccine development as a series of stages, and the first of them can take longer than many people expect: research and discovery in the laboratory often lasts 10 to 15 years. Scientists then use animal studies to check whether the candidate vaccine produces an immune response, a step called proof of concept.

Only after these early steps does the vaccine reach human volunteers, in clinical trials that grow larger at each phase. In Phase 1, a small group of 20 to 100 people receives the trial vaccine so that researchers can study its safety, its side effects, and the immune response it triggers. In Phase 2, the study expands to hundreds of people, often 100 to 300, whose characteristics, such as age and physical health, are similar to those of the people the vaccine is meant for. Phase 3 enlarges the trial to thousands of people, often 1,000 to 3,000. This phase confirms whether the vaccine works and watches for both common and less common side effects. A reaction that affects only one person in a thousand could easily be missed among 50 volunteers, but it has a far better chance of appearing when thousands take part.

When the trials are finished, the company that makes the vaccine submits a license application to the Food and Drug Administration (FDA). The application includes the clinical trial results, details about how the vaccine is made, and the prescribing information. The FDA reviews the trial data to judge whether the vaccine is safe and effective, and it inspects the facility where the vaccine will be produced. Only after the FDA approves a vaccine can the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, consider recommending it. The CDC Director then decides whether to adopt the committee's recommendation.

Approval is not the end of the story. Some vaccines are studied further in Phase 4 trials, which follow safety and effectiveness over a longer period of time. The CDC and FDA also use the Vaccine Adverse Event Reporting System (VAERS), an early warning system to which anyone can report a possible reaction, and the CDC works with several health organizations through the Vaccine Safety Datalink to keep watching vaccines, including newly recommended ones. In other words, the testing that begins in a laboratory keeps going long after a vaccine reaches the public.

How a New Vaccine Earns Its Place

Before a vaccine is offered at a pharmacy or clinic, it travels a long road. The CDC describes vaccine development as a series of stages, and the first of them can take longer than many people expect: research and discovery in the laboratory often lasts 10 to 15 years. Scientists then use animal studies to check whether the candidate vaccine produces an immune response, a step called proof of concept.

Only after these early steps does the vaccine reach human volunteers, in clinical trials that grow larger at each phase. In Phase 1, a small group of 20 to 100 people receives the trial vaccine so that researchers can study its safety, its side effects, and the immune response it triggers. In Phase 2, the study expands to hundreds of people, often 100 to 300, whose characteristics, such as age and physical health, are similar to those of the people the vaccine is meant for. Phase 3 enlarges the trial to thousands of people, often 1,000 to 3,000. This phase confirms whether the vaccine works and watches for both common and less common side effects. A reaction that affects only one person in a thousand could easily be missed among 50 volunteers, but it has a far better chance of appearing when thousands take part.

When the trials are finished, the company that makes the vaccine submits a license application to the Food and Drug Administration (FDA). The application includes the clinical trial results, details about how the vaccine is made, and the prescribing information. The FDA reviews the trial data to judge whether the vaccine is safe and effective, and it inspects the facility where the vaccine will be produced. Only after the FDA approves a vaccine can the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, consider recommending it. The CDC Director then decides whether to adopt the committee's recommendation.

Approval is not the end of the story. Some vaccines are studied further in Phase 4 trials, which follow safety and effectiveness over a longer period of time. The CDC and FDA also use the Vaccine Adverse Event Reporting System (VAERS), an early warning system to which anyone can report a possible reaction, and the CDC works with several health organizations through the Vaccine Safety Datalink to keep watching vaccines, including newly recommended ones. In other words, the testing that begins in a laboratory keeps going long after a vaccine reaches the public.

How a New Vaccine Earns Its Place

Before a vaccine is offered at a pharmacy or clinic, it travels a long road. The CDC describes vaccine development as a series of stages, and the first of them can take longer than many people expect: research and discovery in the laboratory often lasts 10 to 15 years. Scientists then use animal studies to check whether the candidate vaccine produces an immune response, a step called proof of concept.

Only after these early steps does the vaccine reach human volunteers, in clinical trials that grow larger at each phase. In Phase 1, a small group of 20 to 100 people receives the trial vaccine so that researchers can study its safety, its side effects, and the immune response it triggers. In Phase 2, the study expands to hundreds of people, often 100 to 300, whose characteristics, such as age and physical health, are similar to those of the people the vaccine is meant for. Phase 3 enlarges the trial to thousands of people, often 1,000 to 3,000. This phase confirms whether the vaccine works and watches for both common and less common side effects. A reaction that affects only one person in a thousand could easily be missed among 50 volunteers, but it has a far better chance of appearing when thousands take part.

When the trials are finished, the company that makes the vaccine submits a license application to the Food and Drug Administration (FDA). The application includes the clinical trial results, details about how the vaccine is made, and the prescribing information. The FDA reviews the trial data to judge whether the vaccine is safe and effective, and it inspects the facility where the vaccine will be produced. Only after the FDA approves a vaccine can the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, consider recommending it. The CDC Director then decides whether to adopt the committee's recommendation.

Approval is not the end of the story. Some vaccines are studied further in Phase 4 trials, which follow safety and effectiveness over a longer period of time. The CDC and FDA also use the Vaccine Adverse Event Reporting System (VAERS), an early warning system to which anyone can report a possible reaction, and the CDC works with several health organizations through the Vaccine Safety Datalink to keep watching vaccines, including newly recommended ones. In other words, the testing that begins in a laboratory keeps going long after a vaccine reaches the public.

The Doctor Who Asked Colleagues to Wash

Today, cleaning hands before and after touching a patient is one of the most basic rules in any hospital. It was not always so. In the 1840s, the idea that a doctor's own hands could carry disease from one patient to another was still new, and few physicians acted on it.

In 1846, Ignaz Semmelweis, a physician at the General Hospital of Vienna, noticed a troubling pattern. The hospital had two maternity clinics. In the First Clinic, babies were delivered by medical students and physicians; in the Second Clinic, they were delivered by midwives. Mothers in the First Clinic consistently died at a higher rate, many of them from puerperal fever, also called childbed fever. Semmelweis observed that physicians often came to the First Clinic straight from the autopsy room and that their hands still had an unpleasant odor even after washing with soap and water. He proposed that "cadaverous particles" carried on their hands were causing the fever.

Perhaps because chlorine compounds were known to remove odors, Semmelweis required students and physicians, beginning in May 1847, to clean their hands with a chlorine solution between patients. The maternal death rate in the First Clinic then dropped dramatically and stayed low for years. According to the CDC, his work was the first evidence that cleaning heavily contaminated hands with an antiseptic between patient contacts may prevent the spread of disease better than washing with plain soap and water.

Semmelweis was not alone. In 1843, the American physician Oliver Wendell Holmes had independently concluded that childbed fever was spread by the hands of health personnel, but his recommendations had little effect on how doctors practiced at the time. Only gradually did handwashing come to be accepted as one of the most important ways to prevent the spread of germs in health care. In the United States, the CDC published formal written guidelines on handwashing in hospitals in 1975 and again in 1985.

Even so, the lesson has not been fully learned. Although most hospitals have adopted hand hygiene guidelines, the CDC has reported that health care workers' adherence to recommended handwashing practices has remained low. The story that began in a Vienna maternity ward more than 170 years ago is still unfinished.

The Doctor Who Asked Colleagues to Wash

Today, cleaning hands before and after touching a patient is one of the most basic rules in any hospital. It was not always so. In the 1840s, the idea that a doctor's own hands could carry disease from one patient to another was still new, and few physicians acted on it.

In 1846, Ignaz Semmelweis, a physician at the General Hospital of Vienna, noticed a troubling pattern. The hospital had two maternity clinics. In the First Clinic, babies were delivered by medical students and physicians; in the Second Clinic, they were delivered by midwives. Mothers in the First Clinic consistently died at a higher rate, many of them from puerperal fever, also called childbed fever. Semmelweis observed that physicians often came to the First Clinic straight from the autopsy room and that their hands still had an unpleasant odor even after washing with soap and water. He proposed that "cadaverous particles" carried on their hands were causing the fever.

Perhaps because chlorine compounds were known to remove odors, Semmelweis required students and physicians, beginning in May 1847, to clean their hands with a chlorine solution between patients. The maternal death rate in the First Clinic then dropped dramatically and stayed low for years. According to the CDC, his work was the first evidence that cleaning heavily contaminated hands with an antiseptic between patient contacts may prevent the spread of disease better than washing with plain soap and water.

Semmelweis was not alone. In 1843, the American physician Oliver Wendell Holmes had independently concluded that childbed fever was spread by the hands of health personnel, but his recommendations had little effect on how doctors practiced at the time. Only gradually did handwashing come to be accepted as one of the most important ways to prevent the spread of germs in health care. In the United States, the CDC published formal written guidelines on handwashing in hospitals in 1975 and again in 1985.

Even so, the lesson has not been fully learned. Although most hospitals have adopted hand hygiene guidelines, the CDC has reported that health care workers' adherence to recommended handwashing practices has remained low. The story that began in a Vienna maternity ward more than 170 years ago is still unfinished.

The Doctor Who Asked Colleagues to Wash

Today, cleaning hands before and after touching a patient is one of the most basic rules in any hospital. It was not always so. In the 1840s, the idea that a doctor's own hands could carry disease from one patient to another was still new, and few physicians acted on it.

In 1846, Ignaz Semmelweis, a physician at the General Hospital of Vienna, noticed a troubling pattern. The hospital had two maternity clinics. In the First Clinic, babies were delivered by medical students and physicians; in the Second Clinic, they were delivered by midwives. Mothers in the First Clinic consistently died at a higher rate, many of them from puerperal fever, also called childbed fever. Semmelweis observed that physicians often came to the First Clinic straight from the autopsy room and that their hands still had an unpleasant odor even after washing with soap and water. He proposed that "cadaverous particles" carried on their hands were causing the fever.

Perhaps because chlorine compounds were known to remove odors, Semmelweis required students and physicians, beginning in May 1847, to clean their hands with a chlorine solution between patients. The maternal death rate in the First Clinic then dropped dramatically and stayed low for years. According to the CDC, his work was the first evidence that cleaning heavily contaminated hands with an antiseptic between patient contacts may prevent the spread of disease better than washing with plain soap and water.

Semmelweis was not alone. In 1843, the American physician Oliver Wendell Holmes had independently concluded that childbed fever was spread by the hands of health personnel, but his recommendations had little effect on how doctors practiced at the time. Only gradually did handwashing come to be accepted as one of the most important ways to prevent the spread of germs in health care. In the United States, the CDC published formal written guidelines on handwashing in hospitals in 1975 and again in 1985.

Even so, the lesson has not been fully learned. Although most hospitals have adopted hand hygiene guidelines, the CDC has reported that health care workers' adherence to recommended handwashing practices has remained low. The story that began in a Vienna maternity ward more than 170 years ago is still unfinished.

Water: The Nutrient We Forget

Ask people to name an important nutrient, and most will say protein or vitamins. Few will mention water, even though the body depends on it every minute. According to the CDC, water helps keep body temperature normal, cushions and lubricates the joints, protects the spinal cord and other sensitive tissues, and helps the body get rid of waste through urination, sweating, and bowel movements.

The body loses water all day long, and some situations raise the losses. The CDC notes that people need more water in hot climates, when they are more physically active, when they have a fever, and when they have diarrhea or vomiting. When losses are greater than intake, dehydration can develop. MedlinePlus, the National Library of Medicine's health information site, lists the signs of mild to moderate dehydration: thirst, a dry or sticky mouth, urinating less than usual, darker yellow urine, dry and cool skin, headache, and muscle cramps. Severe dehydration can cause dizziness, a rapid heartbeat and breathing, confusion, sunken eyes, and even unconsciousness. Older adults and people with certain diseases, such as diabetes, are at higher risk.

Preventing dehydration is usually simple. MedlinePlus advises drinking plenty of fluids every day, even when you are well, and drinking more in hot weather or during exercise. A person who has a fever, vomiting, or diarrhea should drink plenty of fluids without waiting for signs of dehydration to appear. When someone in a family is sick, others should watch how much that person drinks, paying close attention to children and older adults.

The choice of drink matters, too. Water has no calories, so the CDC points out that replacing sugary drinks with plain water can help reduce the calories a person takes in. Regular sodas, fruit drinks, and sports drinks contain calories but offer little nutritional value. Small habits make water easier to choose: carrying a reusable bottle, ordering water when eating out, serving water at meals, or adding a wedge of lemon or lime for flavor.

Plain water is the most underrated health habit there is. It costs almost nothing, it is available nearly everywhere, and it does not need a marketing campaign. Anyone who wants to feel better this week should start by keeping a full water bottle within reach.

Water: The Nutrient We Forget

Ask people to name an important nutrient, and most will say protein or vitamins. Few will mention water, even though the body depends on it every minute. According to the CDC, water helps keep body temperature normal, cushions and lubricates the joints, protects the spinal cord and other sensitive tissues, and helps the body get rid of waste through urination, sweating, and bowel movements.

The body loses water all day long, and some situations raise the losses. The CDC notes that people need more water in hot climates, when they are more physically active, when they have a fever, and when they have diarrhea or vomiting. When losses are greater than intake, dehydration can develop. MedlinePlus, the National Library of Medicine's health information site, lists the signs of mild to moderate dehydration: thirst, a dry or sticky mouth, urinating less than usual, darker yellow urine, dry and cool skin, headache, and muscle cramps. Severe dehydration can cause dizziness, a rapid heartbeat and breathing, confusion, sunken eyes, and even unconsciousness. Older adults and people with certain diseases, such as diabetes, are at higher risk.

Preventing dehydration is usually simple. MedlinePlus advises drinking plenty of fluids every day, even when you are well, and drinking more in hot weather or during exercise. A person who has a fever, vomiting, or diarrhea should drink plenty of fluids without waiting for signs of dehydration to appear. When someone in a family is sick, others should watch how much that person drinks, paying close attention to children and older adults.

The choice of drink matters, too. Water has no calories, so the CDC points out that replacing sugary drinks with plain water can help reduce the calories a person takes in. Regular sodas, fruit drinks, and sports drinks contain calories but offer little nutritional value. Small habits make water easier to choose: carrying a reusable bottle, ordering water when eating out, serving water at meals, or adding a wedge of lemon or lime for flavor.

Plain water is the most underrated health habit there is. It costs almost nothing, it is available nearly everywhere, and it does not need a marketing campaign. Anyone who wants to feel better this week should start by keeping a full water bottle within reach.

Water: The Nutrient We Forget

Ask people to name an important nutrient, and most will say protein or vitamins. Few will mention water, even though the body depends on it every minute. According to the CDC, water helps keep body temperature normal, cushions and lubricates the joints, protects the spinal cord and other sensitive tissues, and helps the body get rid of waste through urination, sweating, and bowel movements.

The body loses water all day long, and some situations raise the losses. The CDC notes that people need more water in hot climates, when they are more physically active, when they have a fever, and when they have diarrhea or vomiting. When losses are greater than intake, dehydration can develop. MedlinePlus, the National Library of Medicine's health information site, lists the signs of mild to moderate dehydration: thirst, a dry or sticky mouth, urinating less than usual, darker yellow urine, dry and cool skin, headache, and muscle cramps. Severe dehydration can cause dizziness, a rapid heartbeat and breathing, confusion, sunken eyes, and even unconsciousness. Older adults and people with certain diseases, such as diabetes, are at higher risk.

Preventing dehydration is usually simple. MedlinePlus advises drinking plenty of fluids every day, even when you are well, and drinking more in hot weather or during exercise. A person who has a fever, vomiting, or diarrhea should drink plenty of fluids without waiting for signs of dehydration to appear. When someone in a family is sick, others should watch how much that person drinks, paying close attention to children and older adults.

The choice of drink matters, too. Water has no calories, so the CDC points out that replacing sugary drinks with plain water can help reduce the calories a person takes in. Regular sodas, fruit drinks, and sports drinks contain calories but offer little nutritional value. Small habits make water easier to choose: carrying a reusable bottle, ordering water when eating out, serving water at meals, or adding a wedge of lemon or lime for flavor.

Plain water is the most underrated health habit there is. It costs almost nothing, it is available nearly everywhere, and it does not need a marketing campaign. Anyone who wants to feel better this week should start by keeping a full water bottle within reach.

Volunteer With Us at Riverbend Community Hospital

Every week, volunteers at Riverbend Community Hospital greet visitors at the front desk, push wheelchairs to the parking lot, deliver flowers and mail to patient rooms, and keep families company in the surgical waiting area. Last year, 140 volunteers gave more than 9,000 hours of their time. We are looking for new volunteers to join them this spring.

Who can apply: Volunteers must be at least 16 years old. Students who are considering careers in health care are especially welcome, because volunteering is a chance to see how a hospital works from the inside. Each volunteer is asked to commit to one four-hour shift per week for at least six months.

Before your first shift: After you submit an application and complete a short interview, you will attend a three-hour orientation. CDC guidance counts volunteers as health care personnel, a group that includes all paid and unpaid people working in health care settings who could be exposed to patients or infectious materials. For that reason, every new volunteer must complete tuberculosis (TB) screening before starting. The CDC recommends that all U.S. health care personnel be screened for TB when they are hired; the screening includes a risk assessment, a check for symptoms, and a TB blood test or skin test. Volunteers who start during flu season must also show proof of a current flu vaccine, in line with the CDC's recommendation of yearly flu vaccination for health care personnel.

On the job: Volunteers do not provide medical care. They never lift or move patients, and they never give food or drinks to a patient without first checking with the patient's nurse, because some patients have orders not to eat or drink. Volunteers clean their hands right before entering and right after leaving a patient's room, and they keep anything they see or hear about patients private.

Every year, volunteers complete a short refresher course, which includes the yearly TB education that the CDC recommends for all health care personnel.

Ready to apply? Pick up an application at the front desk or call the Volunteer Office at extension 4410. Our volunteers are waiting to welcome you.

Volunteer With Us at Riverbend Community Hospital

Every week, volunteers at Riverbend Community Hospital greet visitors at the front desk, push wheelchairs to the parking lot, deliver flowers and mail to patient rooms, and keep families company in the surgical waiting area. Last year, 140 volunteers gave more than 9,000 hours of their time. We are looking for new volunteers to join them this spring.

Who can apply: Volunteers must be at least 16 years old. Students who are considering careers in health care are especially welcome, because volunteering is a chance to see how a hospital works from the inside. Each volunteer is asked to commit to one four-hour shift per week for at least six months.

Before your first shift: After you submit an application and complete a short interview, you will attend a three-hour orientation. CDC guidance counts volunteers as health care personnel, a group that includes all paid and unpaid people working in health care settings who could be exposed to patients or infectious materials. For that reason, every new volunteer must complete tuberculosis (TB) screening before starting. The CDC recommends that all U.S. health care personnel be screened for TB when they are hired; the screening includes a risk assessment, a check for symptoms, and a TB blood test or skin test. Volunteers who start during flu season must also show proof of a current flu vaccine, in line with the CDC's recommendation of yearly flu vaccination for health care personnel.

On the job: Volunteers do not provide medical care. They never lift or move patients, and they never give food or drinks to a patient without first checking with the patient's nurse, because some patients have orders not to eat or drink. Volunteers clean their hands right before entering and right after leaving a patient's room, and they keep anything they see or hear about patients private.

Every year, volunteers complete a short refresher course, which includes the yearly TB education that the CDC recommends for all health care personnel.

Ready to apply? Pick up an application at the front desk or call the Volunteer Office at extension 4410. Our volunteers are waiting to welcome you.

Volunteer With Us at Riverbend Community Hospital

Every week, volunteers at Riverbend Community Hospital greet visitors at the front desk, push wheelchairs to the parking lot, deliver flowers and mail to patient rooms, and keep families company in the surgical waiting area. Last year, 140 volunteers gave more than 9,000 hours of their time. We are looking for new volunteers to join them this spring.

Who can apply: Volunteers must be at least 16 years old. Students who are considering careers in health care are especially welcome, because volunteering is a chance to see how a hospital works from the inside. Each volunteer is asked to commit to one four-hour shift per week for at least six months.

Before your first shift: After you submit an application and complete a short interview, you will attend a three-hour orientation. CDC guidance counts volunteers as health care personnel, a group that includes all paid and unpaid people working in health care settings who could be exposed to patients or infectious materials. For that reason, every new volunteer must complete tuberculosis (TB) screening before starting. The CDC recommends that all U.S. health care personnel be screened for TB when they are hired; the screening includes a risk assessment, a check for symptoms, and a TB blood test or skin test. Volunteers who start during flu season must also show proof of a current flu vaccine, in line with the CDC's recommendation of yearly flu vaccination for health care personnel.

On the job: Volunteers do not provide medical care. They never lift or move patients, and they never give food or drinks to a patient without first checking with the patient's nurse, because some patients have orders not to eat or drink. Volunteers clean their hands right before entering and right after leaving a patient's room, and they keep anything they see or hear about patients private.

Every year, volunteers complete a short refresher course, which includes the yearly TB education that the CDC recommends for all health care personnel.

Ready to apply? Pick up an application at the front desk or call the Volunteer Office at extension 4410. Our volunteers are waiting to welcome you.

When Germs Fight Back

Antibiotics are among the most important tools in medicine, but they are losing some of their power. The CDC explains that antimicrobial resistance happens when germs such as bacteria and fungi develop the ability to defeat the drugs designed to kill them. Infections caused by resistant germs can be very hard, and sometimes impossible, to treat.

Resistance is a natural process, but the way people use these drugs speeds it up. Antibiotics kill some of the germs that cause an infection, yet they also kill helpful germs that protect the body from infection. Meanwhile, resistant germs survive and multiply, and they can share their resistance with other germs, even ones that were never exposed to the drug. Germs have several ways to resist: some keep a drug from getting inside them, some pump the drug back out, some produce enzymes that break the drug down, and some change the part of the cell that the drug normally attacks. Each new exposure gives the vulnerable germs another chance to die off and the resistant ones another chance to take their place.

The scale of the problem is large. According to the CDC's 2019 report on antibiotic resistance threats, more than 2.8 million antimicrobial-resistant infections occur in the United States each year, and more than 35,000 people die as a result. Worldwide, resistance killed at least 1.27 million people in 2019.

Because every use of an antibiotic gives resistant germs a chance to win, the most effective response is to use these drugs only when they are truly needed. Antibiotics do not work on viruses, such as the ones that cause colds and flu, so taking them for those illnesses brings risk without benefit. The CDC encourages people to talk with their health care provider about whether an antibiotic is needed and to prevent infections in the first place, for example by keeping hands clean and getting recommended vaccines. Patients should also tell their provider if they have recently traveled to, or received medical care in, another country, because modern trade and travel allow resistant germs to move easily across borders.

Resistance cannot be stopped completely, because it is part of how living things adapt. It can, however, be slowed, and every careful decision about antibiotics helps protect these drugs for the patients who will need them in the future.

When Germs Fight Back

Antibiotics are among the most important tools in medicine, but they are losing some of their power. The CDC explains that antimicrobial resistance happens when germs such as bacteria and fungi develop the ability to defeat the drugs designed to kill them. Infections caused by resistant germs can be very hard, and sometimes impossible, to treat.

Resistance is a natural process, but the way people use these drugs speeds it up. Antibiotics kill some of the germs that cause an infection, yet they also kill helpful germs that protect the body from infection. Meanwhile, resistant germs survive and multiply, and they can share their resistance with other germs, even ones that were never exposed to the drug. Germs have several ways to resist: some keep a drug from getting inside them, some pump the drug back out, some produce enzymes that break the drug down, and some change the part of the cell that the drug normally attacks. Each new exposure gives the vulnerable germs another chance to die off and the resistant ones another chance to take their place.

The scale of the problem is large. According to the CDC's 2019 report on antibiotic resistance threats, more than 2.8 million antimicrobial-resistant infections occur in the United States each year, and more than 35,000 people die as a result. Worldwide, resistance killed at least 1.27 million people in 2019.

Because every use of an antibiotic gives resistant germs a chance to win, the most effective response is to use these drugs only when they are truly needed. Antibiotics do not work on viruses, such as the ones that cause colds and flu, so taking them for those illnesses brings risk without benefit. The CDC encourages people to talk with their health care provider about whether an antibiotic is needed and to prevent infections in the first place, for example by keeping hands clean and getting recommended vaccines. Patients should also tell their provider if they have recently traveled to, or received medical care in, another country, because modern trade and travel allow resistant germs to move easily across borders.

Resistance cannot be stopped completely, because it is part of how living things adapt. It can, however, be slowed, and every careful decision about antibiotics helps protect these drugs for the patients who will need them in the future.

When Germs Fight Back

Antibiotics are among the most important tools in medicine, but they are losing some of their power. The CDC explains that antimicrobial resistance happens when germs such as bacteria and fungi develop the ability to defeat the drugs designed to kill them. Infections caused by resistant germs can be very hard, and sometimes impossible, to treat.

Resistance is a natural process, but the way people use these drugs speeds it up. Antibiotics kill some of the germs that cause an infection, yet they also kill helpful germs that protect the body from infection. Meanwhile, resistant germs survive and multiply, and they can share their resistance with other germs, even ones that were never exposed to the drug. Germs have several ways to resist: some keep a drug from getting inside them, some pump the drug back out, some produce enzymes that break the drug down, and some change the part of the cell that the drug normally attacks. Each new exposure gives the vulnerable germs another chance to die off and the resistant ones another chance to take their place.

The scale of the problem is large. According to the CDC's 2019 report on antibiotic resistance threats, more than 2.8 million antimicrobial-resistant infections occur in the United States each year, and more than 35,000 people die as a result. Worldwide, resistance killed at least 1.27 million people in 2019.

Because every use of an antibiotic gives resistant germs a chance to win, the most effective response is to use these drugs only when they are truly needed. Antibiotics do not work on viruses, such as the ones that cause colds and flu, so taking them for those illnesses brings risk without benefit. The CDC encourages people to talk with their health care provider about whether an antibiotic is needed and to prevent infections in the first place, for example by keeping hands clean and getting recommended vaccines. Patients should also tell their provider if they have recently traveled to, or received medical care in, another country, because modern trade and travel allow resistant germs to move easily across borders.

Resistance cannot be stopped completely, because it is part of how living things adapt. It can, however, be slowed, and every careful decision about antibiotics helps protect these drugs for the patients who will need them in the future.

First Day on the Unit

Ana Morales had practiced taking vital signs on her classmates a dozen times, but at 6:45 on the morning of her first clinical shift, her hands would not stop shaking. She checked her name badge, her watch with its second hand, and her pocket notebook for the third time before the elevator doors opened onto the medical floor.

Her assigned nurse, Mr. Delgado, met her at the station with a calm smile. "Everybody's nervous on day one," he said. "The trick is to slow down. Patients can tell when you're rushing."

Their first patient was Mrs. Chen, an 82-year-old woman recovering from pneumonia. Ana reached for the blood pressure cuff the moment she stepped into the room, and Mr. Delgado quietly tapped the hand sanitizer dispenser by the door. Ana's face grew warm. She had recited the rule a hundred times in the skills lab: clean your hands right before you touch a patient and again after. She rubbed the sanitizer over every surface of her hands until they were dry, about twenty seconds that felt like a full minute.

Then she introduced herself, explained what she was about to do, and placed two fingers on Mrs. Chen's wrist. She counted 84 beats in one minute, inside the normal adult resting range of 60 to 100. She counted 16 breaths in the next minute, also inside the normal range of 12 to 18 that she had memorized for her exam.

"You have gentle hands," Mrs. Chen said. "The last student was in such a hurry."

By noon, Ana had checked vital signs on four patients, and she had cleaned her hands before reaching for every one of them. At lunch, Mr. Delgado asked what she had learned. Ana thought about the textbook pages she had highlighted, the normal ranges, the steps she had practiced on mannequins. "That knowing the steps isn't the same as doing them," she said at last. "And that patients notice more than I expected."

Mr. Delgado nodded. "Then it was a good first day."

When the shift ended, Ana turned to a fresh page in her notebook and wrote one line across the top: Slow down. Then she underlined it twice.

First Day on the Unit

Ana Morales had practiced taking vital signs on her classmates a dozen times, but at 6:45 on the morning of her first clinical shift, her hands would not stop shaking. She checked her name badge, her watch with its second hand, and her pocket notebook for the third time before the elevator doors opened onto the medical floor.

Her assigned nurse, Mr. Delgado, met her at the station with a calm smile. "Everybody's nervous on day one," he said. "The trick is to slow down. Patients can tell when you're rushing."

Their first patient was Mrs. Chen, an 82-year-old woman recovering from pneumonia. Ana reached for the blood pressure cuff the moment she stepped into the room, and Mr. Delgado quietly tapped the hand sanitizer dispenser by the door. Ana's face grew warm. She had recited the rule a hundred times in the skills lab: clean your hands right before you touch a patient and again after. She rubbed the sanitizer over every surface of her hands until they were dry, about twenty seconds that felt like a full minute.

Then she introduced herself, explained what she was about to do, and placed two fingers on Mrs. Chen's wrist. She counted 84 beats in one minute, inside the normal adult resting range of 60 to 100. She counted 16 breaths in the next minute, also inside the normal range of 12 to 18 that she had memorized for her exam.

"You have gentle hands," Mrs. Chen said. "The last student was in such a hurry."

By noon, Ana had checked vital signs on four patients, and she had cleaned her hands before reaching for every one of them. At lunch, Mr. Delgado asked what she had learned. Ana thought about the textbook pages she had highlighted, the normal ranges, the steps she had practiced on mannequins. "That knowing the steps isn't the same as doing them," she said at last. "And that patients notice more than I expected."

Mr. Delgado nodded. "Then it was a good first day."

When the shift ended, Ana turned to a fresh page in her notebook and wrote one line across the top: Slow down. Then she underlined it twice.

First Day on the Unit

Ana Morales had practiced taking vital signs on her classmates a dozen times, but at 6:45 on the morning of her first clinical shift, her hands would not stop shaking. She checked her name badge, her watch with its second hand, and her pocket notebook for the third time before the elevator doors opened onto the medical floor.

Her assigned nurse, Mr. Delgado, met her at the station with a calm smile. "Everybody's nervous on day one," he said. "The trick is to slow down. Patients can tell when you're rushing."

Their first patient was Mrs. Chen, an 82-year-old woman recovering from pneumonia. Ana reached for the blood pressure cuff the moment she stepped into the room, and Mr. Delgado quietly tapped the hand sanitizer dispenser by the door. Ana's face grew warm. She had recited the rule a hundred times in the skills lab: clean your hands right before you touch a patient and again after. She rubbed the sanitizer over every surface of her hands until they were dry, about twenty seconds that felt like a full minute.

Then she introduced herself, explained what she was about to do, and placed two fingers on Mrs. Chen's wrist. She counted 84 beats in one minute, inside the normal adult resting range of 60 to 100. She counted 16 breaths in the next minute, also inside the normal range of 12 to 18 that she had memorized for her exam.

"You have gentle hands," Mrs. Chen said. "The last student was in such a hurry."

By noon, Ana had checked vital signs on four patients, and she had cleaned her hands before reaching for every one of them. At lunch, Mr. Delgado asked what she had learned. Ana thought about the textbook pages she had highlighted, the normal ranges, the steps she had practiced on mannequins. "That knowing the steps isn't the same as doing them," she said at last. "And that patients notice more than I expected."

Mr. Delgado nodded. "Then it was a good first day."

When the shift ended, Ana turned to a fresh page in her notebook and wrote one line across the top: Slow down. Then she underlined it twice.

First Day on the Unit

Ana Morales had practiced taking vital signs on her classmates a dozen times, but at 6:45 on the morning of her first clinical shift, her hands would not stop shaking. She checked her name badge, her watch with its second hand, and her pocket notebook for the third time before the elevator doors opened onto the medical floor.

Her assigned nurse, Mr. Delgado, met her at the station with a calm smile. "Everybody's nervous on day one," he said. "The trick is to slow down. Patients can tell when you're rushing."

Their first patient was Mrs. Chen, an 82-year-old woman recovering from pneumonia. Ana reached for the blood pressure cuff the moment she stepped into the room, and Mr. Delgado quietly tapped the hand sanitizer dispenser by the door. Ana's face grew warm. She had recited the rule a hundred times in the skills lab: clean your hands right before you touch a patient and again after. She rubbed the sanitizer over every surface of her hands until they were dry, about twenty seconds that felt like a full minute.

Then she introduced herself, explained what she was about to do, and placed two fingers on Mrs. Chen's wrist. She counted 84 beats in one minute, inside the normal adult resting range of 60 to 100. She counted 16 breaths in the next minute, also inside the normal range of 12 to 18 that she had memorized for her exam.

"You have gentle hands," Mrs. Chen said. "The last student was in such a hurry."

By noon, Ana had checked vital signs on four patients, and she had cleaned her hands before reaching for every one of them. At lunch, Mr. Delgado asked what she had learned. Ana thought about the textbook pages she had highlighted, the normal ranges, the steps she had practiced on mannequins. "That knowing the steps isn't the same as doing them," she said at last. "And that patients notice more than I expected."

Mr. Delgado nodded. "Then it was a good first day."

When the shift ended, Ana turned to a fresh page in her notebook and wrote one line across the top: Slow down. Then she underlined it twice.

Reading the Label Before You Eat

Two boxes of crackers can sit side by side on a grocery shelf, look almost the same, and still be very different foods. The Nutrition Facts label on the side or back of the box is the best way to tell them apart, but only if you know how to read it.

Start at the top, with the serving size. MedlinePlus advises checking the serving size first, because all of the other information on the label is based on it. The Food and Drug Administration (FDA) explains that the serving size reflects the amount people typically eat or drink; it is not a recommendation of how much you should eat. Just below it is the number of servings per container. Many packages hold more than one serving, so a person who finishes a bag that contains three servings has eaten three times the calories and nutrients listed for one serving.

Next comes the calorie count, which tells you the number of calories in one serving. Below that are the nutrients, each followed by a percent Daily Value, or %DV. These percentages are based on 2,000 calories a day, a general guide for nutrition advice, although a person's own needs may be higher or lower. The FDA offers a quick rule for using them: 5% DV or less of a nutrient per serving is considered low, and 20% DV or more is considered high. The rule makes comparison simple. If one cracker lists 18% DV for sodium per serving and another lists 4%, the second is the low-sodium choice, which matters because MedlinePlus advises eating no more than 2,300 milligrams of sodium a day.

The label also shows added sugars. These include sugars put in during processing, such as sucrose or dextrose, as well as sugars from syrups, honey, and concentrated juices.

Learning to read a label takes a few minutes of practice, and it is worth every one of them. A shopper who understands serving sizes and the 5-and-20 rule can compare two products in seconds instead of trusting the pictures and slogans on the front of the box. In a store full of clever marketing, the plain black-and-white label may be the most honest thing on the package.

Reading the Label Before You Eat

Two boxes of crackers can sit side by side on a grocery shelf, look almost the same, and still be very different foods. The Nutrition Facts label on the side or back of the box is the best way to tell them apart, but only if you know how to read it.

Start at the top, with the serving size. MedlinePlus advises checking the serving size first, because all of the other information on the label is based on it. The Food and Drug Administration (FDA) explains that the serving size reflects the amount people typically eat or drink; it is not a recommendation of how much you should eat. Just below it is the number of servings per container. Many packages hold more than one serving, so a person who finishes a bag that contains three servings has eaten three times the calories and nutrients listed for one serving.

Next comes the calorie count, which tells you the number of calories in one serving. Below that are the nutrients, each followed by a percent Daily Value, or %DV. These percentages are based on 2,000 calories a day, a general guide for nutrition advice, although a person's own needs may be higher or lower. The FDA offers a quick rule for using them: 5% DV or less of a nutrient per serving is considered low, and 20% DV or more is considered high. The rule makes comparison simple. If one cracker lists 18% DV for sodium per serving and another lists 4%, the second is the low-sodium choice, which matters because MedlinePlus advises eating no more than 2,300 milligrams of sodium a day.

The label also shows added sugars. These include sugars put in during processing, such as sucrose or dextrose, as well as sugars from syrups, honey, and concentrated juices.

Learning to read a label takes a few minutes of practice, and it is worth every one of them. A shopper who understands serving sizes and the 5-and-20 rule can compare two products in seconds instead of trusting the pictures and slogans on the front of the box. In a store full of clever marketing, the plain black-and-white label may be the most honest thing on the package.

Reading the Label Before You Eat

Two boxes of crackers can sit side by side on a grocery shelf, look almost the same, and still be very different foods. The Nutrition Facts label on the side or back of the box is the best way to tell them apart, but only if you know how to read it.

Start at the top, with the serving size. MedlinePlus advises checking the serving size first, because all of the other information on the label is based on it. The Food and Drug Administration (FDA) explains that the serving size reflects the amount people typically eat or drink; it is not a recommendation of how much you should eat. Just below it is the number of servings per container. Many packages hold more than one serving, so a person who finishes a bag that contains three servings has eaten three times the calories and nutrients listed for one serving.

Next comes the calorie count, which tells you the number of calories in one serving. Below that are the nutrients, each followed by a percent Daily Value, or %DV. These percentages are based on 2,000 calories a day, a general guide for nutrition advice, although a person's own needs may be higher or lower. The FDA offers a quick rule for using them: 5% DV or less of a nutrient per serving is considered low, and 20% DV or more is considered high. The rule makes comparison simple. If one cracker lists 18% DV for sodium per serving and another lists 4%, the second is the low-sodium choice, which matters because MedlinePlus advises eating no more than 2,300 milligrams of sodium a day.

The label also shows added sugars. These include sugars put in during processing, such as sucrose or dextrose, as well as sugars from syrups, honey, and concentrated juices.

Learning to read a label takes a few minutes of practice, and it is worth every one of them. A shopper who understands serving sizes and the 5-and-20 rule can compare two products in seconds instead of trusting the pictures and slogans on the front of the box. In a store full of clever marketing, the plain black-and-white label may be the most honest thing on the package.