Western Nurse & Midwife - Spring 2025

It’s been one year since I had the honour of becoming your State Secretary and I’ve been reflecting on all that’s happened in that time.

We’ve made so much progress and yet, there’s still so much more to do. If I had to summarise the year in one sentence, I’d say we’ve been busy refocusing on what truly matters to members.

A few of my highlights from the year include:

Securing several new EBAs and having a big win with nurse-topatient ratios in select public health wards. While it’s important to celebrate progress like this, the fight isn’t over yet and we’ll keep going until those ratios are extended to every corner of WA’s health service.

Making it easier for members to access advice and support on workplace issues and legal matters by opening our member’s helpline from 9am to 5pm weekdays, with no booking required.

Introducing the Career Compass program, a group coaching course providing career development expertise. I’m pleased to see the amazing feedback coming through from the first members who attended these sessions and we’re working hard to organise more dates, including online options, so we can cover as many members as possible.

ReportSecretary’s

Transforming the holiday unit program in direct response to member’s feedback with a simplified booking process, more flexibility for check-in and checkout, improved cleaning service, no bond requirement, and a removal of the ban list.

Renewing our relationship with the entire federation to ensure we can work together on our common issues and leverage the phenomenal work the federal office and other states are doing to influence impactful changes for nurses, midwives and other healthcare workers across the country.

Updating rules and governance to modernise our rules and make it easier for members to find out what is happening with the union and get involved.

Conducting a thorough review of the union’s operations to ensure every decision is being made with members at the heart. This has resulted in changes to our legal and industrial teams to improve the quality and timeliness of our support while also saving costs. This review unearthed a backlog of unanswered member queries that our industrial advisors diligently worked through and we now have a monitoring system to prevent this happening again. If you are one of the members who was affected by a slow (or non-existent!) response from the union in the past, then I sincerely apologise and assure you that things have changed.

We’ve also been working hard on some important initiatives that will launch soon. This includes our name change which I, like many of you, have been excited to see happen so we can better reflect our membership base and show our midwives and regional members how valued they are.

Our new scholarship program is also commencing with scholarships initially available to eligible members interested in undertaking postgraduate studies in midwifery. More information will be available on our website and iFolio soon. In the coming months, we’ll also be launching a new payment platform to improve cybersecurity and streamline fee payment processes. Keep an eye out for more information about this.

Of course, all of this activity is alongside our ongoing work of advocating for better working conditions and supporting members with individual issues. Throughout the past year, we’ve helped thousands of members who phoned our helpline with industrial matters and queries. As part of our advocacy, we also attended many meetings with members, employers, Government Ministers, political stakeholders, healthcare leaders and more.

Your ANF team is small but mighty and I would like to take a moment to thank them for their hard work over the past year which has led to these achievements and much more.

I’m excited about what the future holds for our union because I’m confident we’re on the right path and that, together, we will continue refocusing our people, resources and time on the areas that matter most to our members so that together we can influence real and lasting change for WA’s entire health sector.

What matters most to

members

On that note, we recently received thousands of responses to our member survey and I’m grateful that so many of you took the time to share your thoughts. The team and I have been reading through your comments and the feedback aligns closely to what I’ve been hearing in person.

As a nurse, I’ve always taken great pride when a patient says they feel heard and respected by their care team and now, as your representative, I believe one of my top priorities is to ensure you feel heard and respected by your union.

For too long, the ANF in WA has talked about taking a member-first approach without acting in a way that matches those words. Throughout the past year, I’ve been getting out to talk to as many members as possible to understand your concerns and priorities to ensure we are focused on the right things.

You can see a summary of the survey insights on page 6. For me, the major takeaways were that you want the ANF to get back to its core purpose. The majority of you think improving wages and workplace conditions should be the union’s top priority. You value professional indemnity insurance, education and development, and the legal assistance and counselling services we provide. Most of you see extra member benefits, like discounts and merchandise, further down the list of priorities.

As your representative, I believe one of my top priorities is to ensure you feel heard and respected by your union.

About 80% of you said you are happy with the services currently provided by the ANF and can see improvement. I’m pleased that many of you can see the result of our efforts over the past year but that still leaves about 20% of you who are not happy and that’s something I take seriously. I understand your concerns about the instability with the union’s leadership changes in recent years and I will continue to focus on providing stable, clear-headed leadership as we move forward.

While we’ve recently experienced a win with ratios in many public healthcare settings, too many of you are still experiencing problems with inadequate staffing levels. I’m also dismayed, yet not surprised, to see so many of you are dealing with workplace bullying, lack of care from management, poor facilities and lack of resources.

Many of you are feeling burnt out, overwhelmed, unsupported and exhausted. As the pillars holding up our healthcare system, it’s not good enough. You deserve more. So, together, we will campaign on these issues to advocate for improvements and better support. In the meantime, if you are struggling and need someone to talk to, please remember the Nurse Midwife Health Program Australia is a confidential, free peer support counselling service, run by nurses and midwives, for nurses and midwives, available Monday to Friday on 1800 001 060.

Another important piece of feedback from the frontline was that you would like the union to be more visible, including in regional areas, and couldn’t agree more! While I will continue to get out to see as many of you in person as I can, we are also planning a total refresh of our delegate and organiser network which will mean we can be ‘on the ground’ at many more workplaces across the state.

Please watch this space for more updates, including how you can get involved if you’re interested in taking on a more active role in the ANF.

We are also taking into account your feedback on how you like to receive information from us and we’ll be reviewing our email updates, social media channels and website as part of this.

You can see that we have a lot of work to do! But I believe that, together, we will meet these priorities and challenges by drawing on the courage, compassion, and commitment that all nurses, midwives and carers show each other and the patients we care for.

Together, we’re not just responding to today’s pressures, but building a healthier, safer, and fairer future for all. The future of our union is written by you, the members, and together, we’re growing stronger.

HIGHLIGHTS FROM THE PAST YEAR

We’re not just responding to today’s pressures, but building a healthier, safer, and fairer future for all. The future of our union is written by you, the members, and together, we’re growing stronger.

OCTOBER

Romina Raschilla appointed ANF State Secretary and ANMF WA State Secretary.

NOVEMBER

Helpline change so members can call without booking an appointment.

DECEMBER

Public Sector members approve EBA offer with highest wage increase in 10 years.

MAY

Career Compass program launches.

APRIL

Ramsay members approve RN EBA offer.

JANUARY

Review of the union’s legal and industrial teams.

MAY

Holiday unit program changes announced.

OCTOBER

Updated the Journal to be Western Nurse and Midwife.

JULY

Historic roll-out of nurseto-patient ratios in select public hospital wards.

SEPTEMBER

WAIRC approved rule changes (initially proposed in April 2025).

WHAT’S NEXT?

JULY

St John of God members approve EBA offer.

AUGUST

Frontline feedback survey issued with over 2,100 responses received.

• Union name change to include midwives

• New payment platform to improve security

• More industrial advisors

• Refreshed delegate / job representative program

• Organisers and more engagement in hospitals

• New scholarship program

• Various campaigns being planned to highlight important issues

ROMINA RASCHILLA ANF STATE SECRETARY

ANF MEMBER’S SURVEY

Issued August 2025

WHAT MEMBERS WOULD LIKE THE UNION TO FOCUS ON OVER 2,100 RESPONSES

INDICATED THEY WORK PART-TIME INDICATED THEY HAVE WORKED IN

FOR

“Be more present in the aged care sector.”

“Can we introduce union representatives for each ward or hospital who can keep in touch with union members and address their issues?”

“Provide more on-site training and workshops for professional development, and enhance communication channels for timely updates on policy changes.”

“Attend rural and remote workplaces, be less Perth-centric.”

“Having more in hospital face-to-face availability to offer advice or support as needed.”

“More transparent information and keeping communication open with members is getting better.”

“Please, no more ventures into politics. Focus on support for members, legal help, advocacy, PII etc, while keeping fees as low as possible.”

power

The of a union: STRONGER TOGETHER

The heart and strength of the Australian Nursing Federation is found in the collective power of its members. Nurses, midwives and carers who choose to stand together every day to protect each other and protect patients.

When someone joins the ANF they’re taking a powerful step. Alone, our voices may be quiet, but TOGETHER, THEY ARE LOUD AND STRONG.

What it’s like to be an ANF member:

1. Joining the union

Every union story begins with the decision to join. By signing up, members are no longer standing alone when it comes to issues like wages, staffing, rostering, workplace bullying or serious workplace investigations.

By pooling resources, members can collectively access professional indemnity insurance and continuing professional development.

Together, union members have the bargaining strength to secure fair pay, safe working conditions, and enforceable rights at work. Joining is the first step to becoming part of a 100-year-strong movement that has achieved real and lasting improvements for WA’s nurses, midwives and carers.

2. Getting involved

The union becomes more impactful, the more involved its members are. From flagging specific workplace issues for attention, to sharing news and feedback from different areas of the health sector to ensure the union remains focused on what matters most.

In recent years, the ANF has not been visible enough in the workplace and there haven’t been enough opportunities for members to get involved. We want that to change and we know you do too!

We’re working hard to improve communication and connection across our membership base – our recent survey and workplace visits are just the beginning and we’ll be sharing many more ways for members to get involved in the coming weeks and months.

3. Demonstrating power

Union power comes to life when members act together, whether that means enforcing safe staffing levels, campaigning for stronger workplace safety standards, or

What the ANF offers members

standing up against unfair treatment. Demonstrating power is not always about rallies or headlines, it can also be about the everyday acts of solidarity and advocacy that build pressure and secure results.

It is at this stage that the union shows employers, governments, and the wider community that WA health professionals cannot be ignored.

4. Representing an area

When a member decides to step up and represent their area, they are ensuring that every member has a voice, no matter what their role, qualification, employer or worksite is. This representation could be as a workplace contact, work health and safety (WHS) representative, delegate or job representative.

These representatives are an important part of any union and we’re in the process of refreshing our network with our key priority being to ensure representatives have the right training and support. No matter how senior their job title is, we see every union representative as an essential workplace leader.

Support is here: It’s

not

weak to speak

Peer support that gets it

When you talk to one of our team, you won’t have to explain the culture, the shift work, the moral challenges, or the weight of responsibility. Our peer clinicians are experienced nurses and midwives and are trained to support their own.

We offer a safe, non-judgmental space to talk about anything, and we’re independent from your employer, university, or regulatory body. You can speak openly.

Why people reach out

People contact us for a range of reasons: emotional exhaustion, grief, anxiety, moral distress, substance use, workplace challenges, or personal struggles. But sometimes the reason is simpler – they just need someone to listen.

Many say they wish they’d contacted us sooner. We want to make seeking support feel normal, expected and safe.

Support is simple and free

No need for a referral or a formal diagnosis; if you’re a nurse, a midwife, a student, a new graduate, or decades into your career, we welcome you.

No

matter where you live or work, help is close.

We offer telephone, telehealth and face-to-face services across Australia.

You can call 1800 001 060, Monday to Friday, 9am to 5pm, or request a callback via our webpage nursemidwifehpa.org.au

You can have a one-off conversation or begin a longer journey with one of our nurse or midwife clinicians.

Either way, we’re here to walk alongside you. You care for others. Let us care for you.

The Nurse Midwife Health Program Australia (NMHPA) is an Australia wide service that every nurse, midwife, and student should know about. It offers a safe, neutral space to talk about your health and wellbeing and it’s free.

Whether you’re navigating stress, burnout, personal challenges, or just feel like something’s not quite right, NMHPA is here to support you.

You care for others – but it’s okay to need support too

The demands of the job –emotionally, physically, ethically – can quietly accumulate over time. Research shows our professions experience higher rates of burnout than many others.

Nurses and midwives are incredibly skilled at caring for others. But many of us find it hard to ask for help ourselves.

Not just another EAP

While your employer may offer an Employee Assistance Program (EAP), some people tell us those services can feel too close to home. NMHPA is different – we’re peer-led, profession-specific, independent, and entirely confidential. We exist solely to support your wellbeing.

Let’s change the story

We believe that seeking support is a strength – not a weakness. Every day, we hear from people who’ve carried silent burdens for months or years.

BECOME AN ANF WORKPLACE LEADER

A workplace leader is someone who steps forward to make sure no one stands alone, and they are the heart of our union.

We are looking for members who want to take an active role in supporting their colleagues and strengthening the union at work. You will be essential in keeping members connected and informed.

As a workplace leader, you will:

Unite your colleagues and keep everyone connected to their union.

Share updates and campaign actions that strengthen our collective voice.

Support campaigns to improve pay, conditions and workplace safety.

Help identify and resolve workplace issues quickly.

Ready to Lead?

Put your hand up today and register your interest in becoming a Workplace Leader

Capel and Donnybrook join WA’s expanding fluoridated water network

Residents of Capel and Donnybrook are now receiving fluoridated drinking water, marking a major milestone in efforts to improve oral health and wellbeing across Western Australia’s South West.

The Department of Health confirmed that fluoridation of both communities’ public water supplies has been successfully completed, extending the rollout that already includes Dalyellup, Bunbury, Eaton, Australind and surrounding areas.

With around 94 per cent of Western Australians already accessing fluoridated water, Capel and Donnybrook now join the wider State initiative to reduce poor dental health through this widely recognised preventative measure.

For more information, community members can visit the HealthyWA website or call the Department of Health on (08) 9222 2000.

Geraldton Health Campus powers ahead with energy module installation

The redevelopment of Geraldton Health Campus has reached a major milestone with the installation of four locally built energy plant modules.

Manufactured in Malaga, these units will provide heating, cooling and electricity through a centralised system, improving efficiency while minimising on-site disruption.

The milestone follows structural works on the new building, now linked to the existing hospital for improved access.

Construction continues on the Acute Mental Health Unit and the expanded Emergency Department.

The $3.2 billion WA health infrastructure program is delivering modern facilities, supporting local businesses with more than $10 million in contracts, and creating jobs across the Mid West.

Specialist Care Nursery opens for Great Southern families

A specialist care nursery has officially opened at Albany Health Campus, allowing more Great Southern families to access critical newborn care closer to home. The Level 2A nursery now supports preterm babies from 34 weeks and infants with complex health needs, doubling capacity to four beds. Previously, many families faced transfers to Perth for treatment.

The expanded service also enables earlier repatriation for babies initially requiring metropolitan care.

Alongside the midwives and paediatricians who staff the nursery, additional registered nurses have been added to the workforce. The facility strengthens local maternity services.

ANMF Nurses & Midwives for Peace

Healthcare workers in conflict zones deliver care under unimaginable conditions, risking their lives to provide essential healthcare.

Join the ANMF’s campaign to stand with frontline nurses and healthcare workers and call for an immediate ceasefire and lasting peace. Scan the QR code to find out more.

Planning your next holiday has never been easier with our

More flexible check-in and check-out days

Maximum stays of 21 nights!

No more bond requirements

No more needing to clean before check-out

Previous ban list wiped

Romina with Royal Perth Bentley Group inductees

Romina with Graduates at Sir Charles Gairdner Hospital

Romina with Graduates at Graylands Hospital

Romina with new grads at SMARTcare7 event at University of Notre Dame

Romina with Royal Perth Bentley Group inductees

Romina with Mel at Sir Charles Gairdner Hospital

Romina with Alex and Jacinta at Sir Charles Gairdner Hospital

Romina with Graduates at Sir Charles Gairdner Hospital

Eleanor Harvey Nurse Society

Congratulations to

The Eleanor Harvey Nurses Society who recently celebrated 100 years of nurses supporting nurses with a members morning tea.

The Eleanor Harvey Nurses Society was founded in 1925 under the original name Society for the Care of Aged or Incapacitated Nurses (Western Australia). It was created to provide accommodation and support for nurses who were no longer able to continue active nursing.

The Society’s home in Claremont, named in honour of Matron Eleanor Alice Harvey, recognised her dedication to nursing and the welfare of her colleagues.

As social and financial conditions evolved, the need for this housing diminished, leading to the sale of the home in 1979. Since then, the Society has broadened its focus, offering financial, emotional and social assistance to nurses facing hardship.

It remains a volunteer-led organisation committed to supporting the nursing community with the spirit of care and solidarity.

FROM

THE CORRIDORS OF NURSING TO THE CORRIDORS OF PARLIAMENT

When the Australian Electoral Commission created the new seat of Bullwinkel, honouring World War II nursing hero Lieutenant Colonel Vivian Bullwinkel and encompassing Darlington, my home for the past 17 years, I saw it as a sign.

By: Trish

Cook, Nurse and Federal Member for Bullwinkel.

Having worked as a nurse and midwife since I was 18-year-old, I put my hand up to represent my community in parliament. I’m now the tenth nurse, and the fourth midwife, to serve in the federal parliament, and I bring with me the values that nursing instils: compassion, advocacy, and a commitment to care.

The first half of my career was spent as a remote-area nurse and midwife in the Pilbara and Kimberley. Working in Indigenous communities such as Ardyaloon, Lombadina, Bidyadanga and Looma, I saw firsthand how the social determinants of health factors such as housing, food security,

education and employment shape health outcomes. Later, I worked in mining towns and on oil and gas sites, often as the only clinician for hundreds of kilometres, relying on Aboriginal health workers, the Royal Flying Doctor Service, and tradies and truck drivers doubling as emergency responders. Those years taught me resilience, responsibility, and the importance of teamwork in the toughest conditions.

I value lifelong education and my PhD is just a few months off completion. I also taught at TAFE and Edith Cowan University.

My career path has been shaped by the values of my parents. My father, Terence, a union leader, was a tireless advocate for working people. My mother, Mary, came to Australia at 12 under the British child migrant scheme in 1947. Despite the hardships of institutional life, she chose nursing,

It was a pleasure to meet and talk to fellow nurse, Trish Cook MP.

a profession of care and service, and inspired me to follow.

It is fitting, then, that my electorate is named after Vivian Bullwinkel. Vivian survived the horrors of the Banka Island massacre and went on to lead with courage and compassion, from serving as matron of Fairfield Infectious Diseases Hospital to lifting nursing education to university level. She is remembered not just as a war hero, but as a leader who transformed nursing in Australia.

Being the first ever Federal Member for Bullwinkel and part of the 48th parliament, I feel I have come full circle. From caring for patients at their most vulnerable moments to now advocating for communities at the national level. Nursing taught me to listen, to act, and to fight for fairness. Those lessons continue to guide me every day.

Romina Raschilla ANF State Secretary and Trish Cook MP met to discuss their nursing careers and the challenges facing today’s nurses and midwives.

Romina Raschilla

This article was written by ANF State Secretary Romina Raschilla and was published in The West Australian newspaper on 30 July 2025.

Nurse-to-patient

ratios aren’t just about numbers on a roster,” says Romina Raschilla.

and management in aged care, often holding multiple jobs at once, I understand the challenges our workforce faces. I’m proud to now stand alongside ANF members, leading our union, supporting the incredible service they provide every day. I know first-hand why we must continue to improve working lives for all nurses, midwives, and carers in WA. This recent victory is a testament to the power of strong, collective advocacy alongside constructive dialogue the ANF has had with local health service providers and the State Government. Nurses and midwives are the voice for progress and practical solutions, but rest assured, we are fierce advocates.

and remote health. Too often, these dedicated professionals are left without the same safeguards now rolling out in metro public settings. They also deserve workplaces where safety, respect, and support are non-negotiable. I am committed to ensuring that our advocacy extends to every corner of the profession so that no nurse, midwife or carer in WA is left behind.

As we roll out nurse-to-patient ratios in our public hospitals, I ask the people of WA to stand with us, your nurses, midwives, and carers. Your support is vital, not just as we expand these life-changing reforms in our public hospitals, but as we continue striving for better working conditions across all areas of our profession.

Romina Raschilla: Nurseto-patient ratios needed in private health settings too

Winter always tests the resilience of our healthcare system, and this year has been no exception.

With a 50 per cent surge in admissions with the flu, our hospitals already under pressure are stretched, patient demand is high, yet as always WA’s nurses and midwives’ dedication remains unwavering.

That is why the roll out of nurse-topatient ratios in public hospitals has been so important. We know from experience that safer staffing saves

lives. Setting strong nurse-to-patient ratios is about guaranteeing quality care for patients and protecting the wellbeing of nurses and midwives who shoulder some of the heaviest burdens in the health sector.

This win comes at a time when workload management is critical, particularly during a challenging winter, and will profoundly impact the ability to deliver the high standards of care all West Australians deserve.

Nurse-to-patient ratios aren’t just about numbers on a roster. It’s about making sure every patient gets the

attention they need, and every nurse and midwife can leave each shift knowing they’ve done their best, without compromising their own health and risk burning out.

When ratios are respected, we see fewer adverse events, better patient outcomes, and improved morale across the board. This change allows nurses to focus on what they do best, delivering compassionate, expert care that genuinely makes a difference in people’s lives.

As a nurse who has worked across public, private, WA Country Health,

Yet, we know many challenges remain, particularly for our colleagues outside of public health in the private sector, aged care, regional

Recently the ANF has seen a lot of change. I have a deep aspiration to build a union shaped by, and for its members. I am committed to listening and learning directly from the frontline, so we can keep advancing workplace conditions and rights for all healthcare professionals, through strong workforce planning, safe staffing, and ensuring our voices are always heard at every decisionmaking table.

Count the babies

The introduction of nurse-to-patient ratios in select public hospital wards is a major victory for our members, but the fight isn’t over yet. We’ll keep going until those ratios are extended to every corner of WA’s health service.

It’s vital that both mothers and babies are counted as patients in midwifery ratios. Counting each baby will ensure safe staffing, better care and improved outcomes for families.

Together, with the strength of our union and the backing of the public we care for, we can ensure that every nurse, midwife, and carer have a safe, supportive workplace they deserve, so that every West Australian receives the quality care they need. The future of health care is stronger when we all stand together.

“Maintaining appropriate midwifeto-patient ratios is crucial to ensure safe, high-quality care, attentiveness to both maternal and neonatal needs, and favourable health outcomes. It is essential to include babies in these ratios to accurately reflect the workload and care requirements. These ratios should be adjusted according to factors such as the complexity of cases, the care setting, and specific patient needs to optimise care effectiveness and safety.”

ROMINA RASCHILLA

Romina Raschilla is the WA State Secretary of the Australian Nursing Federation

Romina Raschilla ANF State Secretary, joined by Hon Meredith Hammat MLA Minister for Health; Mental Health visited Royal Perth Hospital to hear first-hand how the new ratios are working for members.

Ratios

Nurse and

midwife ratios

are becoming a reality in WA public hospitals. This guide breaks down what’s happening, when, and why it matters.

What are nurse-to-patient ratios?

Ratios set the minimum number of nurses or midwives required to care for patients during each shift.

They help ensure safe, consistent care – and healthier, more sustainable workplaces for all.

What are the new minimum ratios?

In WA public hospital medical and surgical wards, the following apply:

Morning and afternoon shifts (7:00am–9:00pm):

• 1 nurse to every 4 patients, plus

1 Hands-Free Shift Coordinator (HFSC)

Night shift (6:30pm–7:30am):

• 1 nurse to every 7 patients

The HFSC is a senior nurse or midwife who supports the team and does not carry a patient load.

Where are these ratios being introduced?

Ratios are being phased in across metropolitan public hospitals, including:

• Sir Charles Gairdner, Osborne Park, Royal Perth, Fiona Stanley, Fremantle and Rockingham General

• Perth Children’s Hospital

With further rollouts to follow across other eligible medical and surgical wards.

How will this be monitored?

• Hospitals are required to report any shift that does not meet ratio requirements

• Monitoring begins 4 months after implementation on each ward

• A formal compliance process follows 8 months after the start date

• Workload concerns can be raised through the agreed escalation process, and support is always available.

What if my ward isn’t included yet?

Right now, ratios apply to metropolitan medical and surgical wards.

Other areas will continue using the existing Nursing Hours Per Patient Day model until their implementation phase begins.

The ANF remains committed to ensuring safe staffing for all settings and specialties.

We’ll continue working closely with members and health services to support future rollout.

Why does this matter?

This achievement reflects what’s possible when nurses and midwives stand together – and when your voices are heard.

It’s a step toward more sustainable workloads, improved patient care, and a safer future for everyone in our health system.

‘Just a quick chat’

What to say when your manager asks for one

In our work supporting members across the health sector, our Industrial Team has seen examples where ‘just a quick chat’ with a manager turns out to be a formal meeting with potentially serious implications.

While it may sound harmless, these spur-of-the-moment meetings can quickly shift from casual conversations to disciplinary discussions.

Without prior notice, you’re placed at a disadvantage – caught off guard, unable to prepare ahead of time, and without a support person present.

WHY IT MATTERS

You have rights to procedural fairness. This includes the right to:

• Be notified in advance if the meeting could result in disciplinary action.

• Know the purpose of the meeting.

• Be given enough time to prepare your response to any allegations or ‘concerns’ that they put to you, including the right to provide a written response if you prefer.

• Bring a support person – or if appropriate, your union representative – to the meeting with you. Remember that your choice of support person cannot be unreasonably refused.

Too often, our team sees cases where these rights are bypassed, with members only realising after the fact that the ‘quick chat’ was, in fact, the beginning of formal disciplinary proceedings. This can seriously impact your employment and your ability to respond appropriately to allegations.

You should always remember that any so-called ‘quick chat’ or ‘informal meeting’ in these circumstances is never off-the-record.

Everything you say to your employer can be used against you down the line, for example in more formal proceedings.

WHAT TO SAY

If you’re invited to a meeting unexpectedly and you’re unsure of its purpose, you are within your rights to say:

“Can I please confirm what this meeting is about?”

Depending on your manager’s response, you can then say:

“If the meeting relates to my performance or conduct, I would like to have a support person present and time to prepare.”

This is not being difficult, this is being smart. It’s about protecting your rights and ensuring a fair process.

WE’RE HERE TO SUPPORT YOU

Your union is here for exactly these situations. If you’re ever uncertain about a meeting or feel pressured to attend without support, contact the ANF Industrial Team on 08 6218 9444 or anfindustrial@anfiuwp.org.au

We can help assess the situation, provide advice, and if needed, provide you with representation.

Meal timing crucial for night shift worker health

Overnight eating may be putting night shift workers at higher risk of chronic health conditions.

South Australian researchers found blood glucose levels skyrocketed in study participants who either snacked or ate full meals at night putting their health at increased risk.

Led by researchers from the University of South Australia (UniSA), University of Adelaide and South Australian Health and Medical Research Institute (SAHMRI), the research involved a six-day trial with 55 adults in the healthy BMI range who don’t usually work night shifts. Study participants were divided into three groups: those who fasted at night, those who had snacks, and those who ate full meals.

All participants stayed awake for four nights and slept during the day, with a recovery day on day five to reestablish normal sleeping and eating cycles, and blood glucose testing on day six.

Results showed participants who ate meals or snacks during the night shift had significantly worse glucose tolerance compared to those who fasted.

“We found that blood glucose skyrocketed for those who ate full meals at night and those who snacked, while the people who fasted at night showed an increase in insulin secretion which kept blood sugar levels balanced.

“We know shift workers are more likely to have diabetes, they’re more likely to have heart disease, and they’re more likely to be overweight. Our research suggests that meal timing could be a major contributor to those issues,” said Professor Leonie Heilbronn, from the University of Adelaide.

Insulin sensitivity was disrupted among all participants, regardless of their eating habits, adding to the body of evidence that night shifts cause circadian misalignment and impair glucose metabolism.

When you eat a meal, your body secretes insulin, and that insulin helps your muscles and other tissues to take up glucose. If you become resistant to insulin, then you can’t take up that glucose as effectively into your muscles and if it continues, that potentially puts you at risk of diabetes.

We know night shift workers are more likely to have:

Not eating large meals while working night shift and instead eating primarily during the day could be a straightforward intervention to manage health outcomes for many workers, said lead investigator UniSA Professor Siobhan Banks.

“This could be easier for people to follow than other more complex diets.”

Future trials will investigate whether eating only protein snacks on night shift is a potential solution to satiating hunger without predisposing workers to negative health consequences.

The study was published in Diabetologia This article was originally published on  www.anmj.org.au

Your retirement countdown: Essential steps at every stage

For many Australians, retirement planning feels overwhelming and uncertain. Almost two thirds of Australians over 45 are feeling concerned or anxious about it. Starting to plan early and taking a structured approach can make all the difference. The key is understanding what steps to take at each crucial stage leading up to retirement.

10 YEARS OUT:

Breaking through the planning paralysis

Most Australians experience what superannuation experts call the ‘oh crap!’ moment somewhere between ages 55-65, when retirement suddenly feels real. The reality is that it’s difficult to envision life more than 15 years ahead, which explains why many people aren’t engaged with their super until this point.

At this stage, the most common concerns revolve around three fundamental questions: How much money will I need in retirement? Will I have enough to last? Am on track now? These anxieties are often triggered by major life events like marriage, divorce, having children, or losing a loved one.

Rather than getting overwhelmed by conflicting media reports about retirement savings targets, focus on understanding your current spending patterns and the lifestyle you want in retirement. Consider factors like whether you’ll still have a mortgage, your eligibility for the age pension, and your health and life expectancy.

Remember, retirement could span 30 years or more given increasing life expectancies.

Key Action: Use retirement planning tools to get a clear picture of your trajectory. Aware Super’s My Retirement Planner™ uses longterm averages on inflation and investment returns to forecast your retirement position based on your desired lifestyle. This tool can show you exactly how much you’re likely to have in super and your probable retirement income, including age pension entitlements.

FIVE YEARS OUT:

Fine-tuning your strategy

As retirement becomes more tangible in your late 50s and early 60s, it’s time to consider adjusting your investment approach. You may want to reduce exposure to riskier assets to protect against market downturns, though maintaining some growth exposure often remains important.

Your risk tolerance should factor in not just your age, but how long until retirement, your overall financial situation, income stability, other investments, and your health.

For someone five years from retirement, a balanced investment option could be suitable, but professional advice is invaluable in case you need a tailored solution.

retired. On retirement at any age after preservation age, your super can move to a Retirement Income Account where investment returns become tax-free and withdrawal restrictions are removed.

Allocated pensions (account-based pensions) are the most popular retirement income choice, though most Australians who choose a retirement income product take their fund’s default option. It’s worth exploring your options, as staying within the super system provides better returns and tax benefits than withdrawing everything.

Key considerations include the Transfer Balance Cap (currently $2.0 million for 2025), which limits how much you can transfer into tax-free retirement phase. Any excess remains in an accumulation account, taxed at up to 15%.

Keep in mind you must meet a Condition of Release before you can start an income stream, one of which is reaching 60 years of age and having ceased paid work.

Flexibility for the future Retirement isn’t a one-way street. ‘Unretirement’ is increasingly common, with people returning to work after initially retiring.

You can continue receiving Retirement Income Account payments even after returning to work, though you’ll need to open a new accumulation account for any new employer contributions.

Aware Super’s MySuper Lifecycle approach gradually reduces investment risk once members reach their mid-50s, to help preserve their investment gains.

Transition to Retirement Accounts: Many Australians ease into retirement by reducing their working hours.

A Transition to Retirement (TTR) account can bridge the income gap during this phase.

Once you reach preservation age (60 for most readers), you can transfer your entire super balance to a TTR account, drawing between 4-10% annually. For those over 60, these drawdowns are tax-free, though investment returns are still taxed at 15%.

A TTR strategy can also boost your final super balance through salary sacrifice, where you use TTR payments to replace some salary and redirect that salary into super as concessional contributions.

ONE YEAR OUT:

Understanding your options

At this crucial stage, you need to understand how super can provide retirement income. From age 65, you can withdraw some or all of your super balance completely taxfree, regardless of whether you’ve

Important Preparation: Start linking Centrelink to your MyGov account to streamline future Age Pension applications. Begin planning your day-to-day living costs and budget, considering how expenses might change – some costs may decrease while others, like healthcare, might increase.

SIX MONTHS OUT:

Making it happen

With six months until retirement, it’s time to turn your superannuation into a steady income stream. Contact your super fund 4-8 weeks before retirement to discuss your Retirement Income Account options.

The Process: Setting up a Retirement Income Account is surprisingly straightforward. With Aware Super, once you determine your desired payment frequency and investment choice, the online application takes about 15 minutes, and payments can start within three days.

Expert Support: Take advantage of free advice services. Aware Super’s Retire Ready Check-in provides a nocost session with a retirement expert to review your super, goals, and account options, ensuring confidence in your plan.

Maintaining growth in retirement

Even in retirement, maintaining some exposure to growth assets is often wise. With Australians increasingly living into their 90s, your retirement could span decades.

Investment returns typically make up about a third of retirement income, so ensuring your money continues working hard remains important.

Many retirees stick to minimum drawdown limits (4-5% annually based on age) out of fear of running out of money.

Speaking with a retirement expert can help determine an appropriate drawdown level that allows an enjoyable retirement without premature exhaustion of funds.

Taking a staged approach to retirement planning, with specific actions at each key milestone, can transform what feels like an overwhelming challenge into a manageable process.

The key is starting early, staying informed, and taking advantage of the expert guidance and tools available through your superannuation fund.

performance and 8.54% for the lower return scenario based on SuperRatings SR50 Growth Index’s 15-year median return as at December 2024. Actual returns year on year may vary materially and can be negative as well. If investment returns/inflation are higher/lower, final balances will differ. This example is for illustrative purposes only and is not intended to provide a guarantee on outcome. It is a broad illustration of the steps a member could take, but the actions appropriate for an individual will vary depending on their personal circumstances. The case study is based on current regulatory requirements and laws, including tax rates, which may be subject to change. Consider if this is right for you and read our Product Disclosure Statement (PDS) and Target Market Determination (TMD) before making a decision about Aware.

Aware Super’s High Growth option return over 10 years to 30 June 2025. SuperRatings Fund Crediting Rate Survey, June 2025. Based on the SR50 Growth (77-90) Index. Returns are after tax and investment management expenses but before the deduction of administration fees. Past performance is not an indicator of future performance.

General advice only. Consider your objectives, financial situation, or needs, which have not been accounted for in this information and read the PDS and TMD at aware.com.au/pds before acting. Issued by Aware Super Pty Ltd (ABN 11 118

National Principles for Child Safe Organisations: a clinical update

ANF iFOLIO CLINICAL UPDATE:

National Principles for Child Safe Organisations: a clinical update

Read this article and complete the quiz to earn 1 iFolio hour

Children have the same human rights as adults. They also have the right to special protection and care because of their physical and mental immaturity and vulnerability to neglect, exploitation, and abuse.1,2

Children have the same human rights as adults. They also have the right to special protection and care because of their physical and mental immaturity and vulnerability to neglect, exploitation, and abuse.1,2

In Australia a wide range of organisations work with children, including hospitals and schools. Organisations working with children should provide safe environments in which children’s interests, needs, and rights are met.1

A child safe organisation deliberately and systematically:1

• Creates an environment where safety and wellbeing are the centre of thoughts, values, and actions

their

participate in decisions affecting them and are taken seriously.

• Implementation of the Principles is regularly reviewed and improved

• Policies and procedures document how the organisation is safe for children.

The Principles are interrelated and should be considered holistically.4,5

Principle 1: Leadership, governance, and culture

Child safe organisations value children and understand that safety requires an ongoing commitment through all levels of the organisation.

Leaders prioritise safety and ensure the Principles are embedded in organisational culture and are understood and accepted across the organisation.

Everyone in the organisation knows how, and feels confident, to raise concerns.1,4 Key actions include:1,5

• A child safe culture is championed and modelled at all levels of the organisation

• Staff are attuned to signs of harm and facilitate child-friendly ways for children to express their views, participate in decision-making, and raise their concerns.

Principle 3: Involving family and community

Family has the primary responsibility for raising a child, and families and carers are best placed to advise organisations about the child’s capabilities and needs, and the practices and environments that are safe for the child.

Recognising and valuing the diversity in family cultures, backgrounds and structures creates a safe environment, in which children, family and community members feel that their culture and identity are respected.1,4 Key actions include:1,5

• Families participate in decisions affecting their child

• Access to information, support, and complaints processes are provided in ways that are culturally safe, accessible, and easy to understand.

Principle 5: Managing staff

Robust and transparent recruitment and selection process to identify suitable staff are a foundation of child safe organisations.1,4

Child safe organisations also support staff through induction, training on child safety responsibilities and cultural safety, and ongoing support and supervision.1,4,5 Key actions include:1,5

• Recruitment emphasises child safety and wellbeing

• Staff receive an appropriate induction and are aware of their responsibilities to children, including record keeping, information sharing, and reporting obligations

• Families and communities have a say in the development and review of policies and practices

• Emphasises genuine engagement with and valuing of children

• Creates conditions that reduce the likelihood of harm and increase the likelihood of identifying harm

• Responds to any concerns, disclosures, or suspicions of harm.

In Australia a wide range of organisations work with children, including hospitals and schools. Organisations working with children should provide safe environments in which children’s interests, needs, and rights are met.

A child safe organisation deliberately and systematically:1

The National Principles for Child Safe Organisations (the Principles) provide a national approach to embedding a child safe culture across all organisations, and all levels within organisations, that work with children.1,3

• Creates an environment where safety and wellbeing are the centre of thoughts, values, and actions

THE PRINCIPLES

• Emphasises genuine engagement with and valuing of children

The Principles, committed to by all Australian governments, outline the fundamental elements for making organisations safe for children.1,3

The 10 Principles are (see Illustration 1): 1

• Transparent governance arrangements facilitate implementation of a child safety policy at all levels

• Staff understand their obligations on behavioural standards, responsibilities, and information sharing and record-keeping.

Principle 2: Empowering children to participate

• Families, carers, and the community are informed about the organisation’s governance and operation.

Principle 4: Upholding equity upheld and respecting diversity

• Supervision and people management is focused on child safety and wellbeing.

Principle 6: Child focused complaint process and reporting Complaint processes are an important mechanism for identifying and correcting mistakes and protecting children from harm.

• Creates conditions that reduce the likelihood of harm and increase the likelihood of identifying harm

• Physical and online environments promote safety and wellbeing while minimising the opportunity for children to be harmed

• Child safety and wellbeing is embedded in organisational leadership, governance, and culture

• Responds to any concerns, disclosures, or suspicions of harm.

• Children are informed about their rights, participate in decisions affecting them, and are taken seriously

THE PRINCIPLES

• Implementation of the Principles is regularly reviewed and improved

• Transparent governance arrangements facilitate implementation of a child safety policy at all levels

• Equity is upheld and diverse needs respected in policy and practice

• Staff understand their obligations on behavioural standards, responsibilities, and information sharing and recordkeeping.

Supporting children to understand what child safety means, and focusing on empowering and encouraging participation in decision-making in age-appropriate ways are key aspects of building capacity for child safe organisations. 5

Recognising the strengths and individual characteristics of each child and embracing all children regardless of age, sex, gender, ability, and background enables organisations to work in a more child centred way, allows children to feel comfortable, and empowers children to participate more effectively.1,4,5 Key actions include:1,5

Empowering and supporting children to raise concerns and responding to concerns and complaints is a fundamental part of ongoing organisational development.4,5 Key actions include:1,5

• Families and communities are informed and involved in promoting child safety and wellbeing

• Equity is upheld and diverse needs respected in policy and practice

• People working with children are suitable and supported to reflect child safety and wellbeing values in practice

The National Principles for Child Safe Organisations (the Principles) provide a national approach to embedding a child safe culture across all organisations, and all levels within organisations, that work with children.1,3

• Processes to respond to complaints and concerns are child focused

• Staff and volunteers are equipped with the knowledge, skills, and awareness to keep children safe through ongoing education and training

• Policies and procedures document how the organisation is safe for children.

The Principles are interrelated and should be considered holistically.4,5

The Principles, committed to by all Australian governments, outline the fundamental elements for making organisations safe for children.1,3 The 10 Principles are (see Illustration 1):1

Principle 1: Leadership, governance, and culture

• Child safety and wellbeing is embedded in organisational leadership, governance, and culture

• Children are informed about their rights, participate in decisions affecting them, and are taken seriously

Child safe organisations value children and understand that safety requires an ongoing commitment through all levels of the organisation. Leaders prioritise safety and ensure the Principles are embedded in organisational culture and are understood and accepted across the organisation. Everyone in the organisation knows how, and feels confident, to raise concerns.1,4 Key actions include:1,5

• Families and communities are informed and involved in promoting child safety and wellbeing

• A child safe culture is championed and modelled at all levels of the organisation

Principle 2: Empowering children to participate

• People working with children are suitable and supported to reflect child safety and wellbeing values in practice

Supporting children to understand what child safety means, and focussing on empowering and encouraging participation in decisionmaking in age-appropriate ways are key aspects of building capacity for child safe organisations.5 It requires staff recognising and respecting children’s identities and cultures, understanding their developmental needs, and building on their strengths and capacities.1 Key actions include:1,5

• Processes to respond to complaints and concerns are child focused

• Staff and volunteers are equipped with the knowledge, skills, and awareness to keep children safe through ongoing education and training

• Children are informed about their rights, including to safety, information, and participation

• The importance of friendship is

• Physical and online environments promote safety and wellbeing while minimising the opportunity for children to be harmed

It requires staff recognising and respecting children’s identities and cultures, understanding their developmental needs, and building on their strengths and capacities. Key actions include:1,5

• Children are informed about their rights, including to safety, information, and participation

• The importance of friendship is recognised and support from peers is encouraged

• Children’s diverse circumstances are recognised, and the organisation provides support and responds to those who are vulnerable

• Particular attention is given to the needs of First Nations children, children with disability, children from culturally and linguistically diverse backgrounds, lesbian, gay, bisexual, transgender and intersex children, and children who are unable to live at home

• The complaints policy is accessible and child focused, and clearly outlines the roles and responsibilities of leadership and staff, and approaches to dealing with different types of complaints

• Effective and culturally safe complaint handling processes are understood by children, families, and staff

• Complaints are taken seriously, recorded, analysed, and responded to promptly, fairly, and thoroughly.

Principle 7: Education, training, and development

Ongoing education and training ensures staff develop awareness and insights into their attitudes towards children, maintain a contemporary understanding of child development, safety, and wellbeing, and have the information to understand their responsibilities and perform their roles effectively.1,4 Key actions include:1,5

• Staff are trained and supported to effectively implement the child safety and wellbeing policy

• Staff receive training and information to recognise indicators of child harm, to respond effectively to issues of child safety and wellbeing, and to support colleagues who disclose harm

• Staff receive training and information on how to build culturally safe environments for children.

Principle 8: Safe physical and online environments

Considering the risks posed by physical and online environments and how they may be mitigated is an important mechanism to prevent harm.

Risk management strategies must identify where the physical environment is unsafe, and where adult-to-child or child-to-child interactions occur in physical or online environments.1 Key actions include:1,5

• Staff proactively identify and mitigate risks in the physical and online environments without compromising a child’s right to privacy, access to information, social connections, and learning

• Risk management plans consider risks posed by the physical environment and organisational settings and activities

• Organisations that contract with third parties have procurement policies that ensure the safety and wellbeing of children.

Principle 9: Regular review and improvement

Creating and maintaining a child safe organisation is a dynamic and ongoing process of monitoring, reviewing, reflecting, and improving.

Organisations must remain attentive and responsive, and continuously seek to improve the delivery of child safe services.1,5 Key actions include:1,5

• Child safe practices are regularly reviewed, evaluated, and improved, and the review process involves children, their families, and the community

• Complaints, concerns, and safety incidents are analysed to identify causes and systemic failures, and inform continuous improvement

• Review findings are reported to staff, children, their families, and the community.

Principle 10: Child safe policies and procedures

Documenting child safe policies and procedures ensures consistent implementation of child safe practices across the organisation and enables organisations to review adherence to the Principles. Key actions include:1,5

• Policies and procedures are documented in a format and language that is easy to understand and accessible to staff, children, their families, and the community

• Policy and procedure development is informed by best practice models and stakeholder consultation

• Leaders within the organisation champion and model compliance with policies and procedures

• Staff understand the policies and procedures, and practice across the organisation is compliant with the policies and procedures.

REFERENCES

1. Australian Human Rights Commission. National Principles for Child Safe Organisations [Internet]. Sydney (Australia): Australian Human Rights Commission; 2018 [cited 2023 May 21]. Available from: https:// childsafe.humanrights.gov.au/ sites/default/files/2019-02/ National_Principles_for_ Child_ Safe_Organisations2019.pdf

2. United Nations General Assembly, Convention on the Rights of the Child, 20 November 1989 [cited 2023 May 21]; UNTS 1577 (entered into force 2 September 1990). Available from: https://www. ohchr.org/en/professionalinterest/ pages/crc.aspx

3. Government of Western Australia. National Principles for Child Safe Organisations [Internet]; 2023 [cited 2023 May 21]. Available from: https://www.wa.gov.au/ organisation/department-ofcommunities/national-principleschild-safe-organisations

4. Commissioner for Children and Young People Western Australia. National Principles for Child Safe Organisations WA: In brief [Internet]. Subiaco (Australia): Commissioner for Children and Young People; 2019 [cited 2023 May 21]. Available from: https:// www.ccyp.wa.gov.au/media/3947/ child-safe-organisations-in-briefupdated-november-2019.pdf

5. Commissioner for Children and Young People Western Australia. National Principles for Child Safe Organisations WA: Guidelines [Internet]. Subiaco (Australia): Commissioner for Children and Young People; 2019 [cited 2023 May 21]. Available from: https:// www.ccyp.wa.gov.au/media/3946/ child-safe-organisationswa-guidelines-updatednovember-2019.pdf

Semaglutide: a medication update

Brand name: Ozempic1

Drug class: glucagon-like peptide-1 analogues1

MECHANISM OF ACTION

Glucagon-like peptide-1 (GLP-1) is a physiological hormone with multiple actions in glucose and appetite regulation and the cardiovascular system.2,3 GLP-1 receptors in the pancreas and brain regulate glucose and appetite effects, while GLP-1 receptors in the heart, vasculature, immune system, and kidneys mediate cardiovascular effects. 2

Semaglutide is a GLP-1 analogue, with 94% sequence homology to GLP-1.3 However, it has a prolonged half-life compared to native GLP-1, due to decreased renal clearance and protection from metabolic degradation. Semaglutide acts as a GLP-1 receptor agonist, binding to and activating GLP-1 receptors. 2,3

Semaglutide promotes glycaemic control through a range of mechanisms including increasing glucose-dependent insulin secretion, inhibiting glucose-dependent glucagon secretion, and slowing gastric emptying, which slows glucose absorption.1,2,3

Semaglutide also reduces body weight and body fat mass through reduced appetite and energy intake, and delayed gastric motility. 2,3

ADMINISTRATION

Semaglutide is administered subcutaneously. Injections are administered in the abdomen, thigh, or upper arm. 3

INDICATIONS

Semaglutide is indicated for insufficiently controlled type 2 diabetes in adults. It is indicated as monotherapy when metformin is not tolerated or is contraindicated, or as an adjunct to other pharmacotherapies for the treatment of type 2 diabetes. 3 It is also prescribed ‘off-label’ for weight loss.4

CONTRAINDICATIONS

Semaglutide is contraindicated in patients with hypersensitivity to semaglutide. 3

INTERACTIONS

Concurrent use of semaglutide with sulfonylurea or insulin may increase the risk of hypoglycaemia. 3,5 The risk of hypoglycaemia may be decreased by reducing the dose of sulfonylurea or insulin when initiating treatment with semaglutide. 3 If semaglutide is used concurrently with sulfonylurea or insulin, blood glucose level monitoring may be required and the sulfonylurea or insulin dose should be reduced if necessary. 3,5

DOSAGE

As semaglutide has a half-life of approximately one week it is suitable for a weekly dose. 3

Semaglutide is initiated as a once weekly dose of 0.25mg for four weeks. 3 After four weeks the dosage is increased to 0.5mg once weekly (0.25mg is not a maintenance dose). After at least another four weeks, the dose may be increased to 1mg once weekly if required to further improve glycaemic control.1,3

The semaglutide dose should be administered on the same each week. The dosing day can be changed, if necessary, as long as there is at least 72 hours between doses. After selecting a new dosing day, a onceweekly dosing schedule should be continued. 3

Missed doses

If less than five days has lapsed since the last dose was administered, the dose should be administered as soon as possible, and the weekly dosing schedule resumed on the regular scheduled day.

If more than five days has lapsed since the last dose was administered, the dose should be skipped and the next dose administered on the regular scheduled day and the weekly dosing schedule resumed. 3

PRECAUTIONS

Renal impairment

There is limited evidence on the safety of semaglutide in patients with severe renal impairment with creatinine clearance (CrCl) of less than 30mL/minute. Semaglutide is not recommended for use in patients with end-stage renal disease. 3

Hepatic impairment

Semaglutide should be used with caution in patients with severe hepatic impairment. There is limited evidence on the safety of semaglutide in these patients. 3

Gastrointestinal conditions

Semaglutide is associated with adverse effects on the gastrointestinal tract. It should not be used in patients with severe gastrointestinal disease, such

as gastroparesis and dumping syndrome.1

Pregnancy and breastfeeding Semaglutide should not be used during pregnancy.1,3 It has been associated with reproductive toxicity in animal studies and may cause fetal malformations or irreversible damage.

Women using semaglutide should use effective contraception and discontinue treatment at least two months before a planned pregnancy. 3

Semaglutide should not be used while breastfeeding. It has not been established as safe for use while breastfeeding. 3

ADVERSE EFFECTS

The most common adverse effects associated with semaglutide are nausea, vomiting, constipation, and diarrhoea. 3

These effects are generally of mild to moderate severity and improve with continued use of semaglutide.

Other common adverse effects include abdominal pain, dyspepsia, gastro-oesophageal reflux disease, fatigue, dizziness, increased heart rate, hypoglycaemia, diabetic retinopathy complications, antidrug antibodies, and injection site reactions, such as rash and erythema.1,3

Semaglutide may infrequently be associated with cholecystitis (gallbladder inflammation), cholelithiasis (gallstones), and dysguesia.1,3

Rarely semaglutide is associated with pancreatitis, altered renal function, acute renal failure, worsening of chronic renal failure, and allergic reactions, including anaphylaxis and angioedema.

REFERENCES

1. Semaglutide. 2023 [cited 2023 Jun 2]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https:// amhonline. amh.net.au/chapters/ endocrine-drugs/drugs-diabetes/ glucagon-like-peptide-1analogues/semaglutide

2. Mahapatra MK, Karuppasamy M, Sahoo BM. Semaglutide, a glucagon like peptide-1 receptor agonist with cardiovascular benefits for management of type 2 diabetes. Rev Endocr Metab Disord [Internet]. 2022 [cited 2023 Jun 3];23(3):521-539.

3. Therapeutic Goods Administration (TGA). Australian Product Information: Ozempic (semaglutide) solution for injection [Internet]. Woden (Australia): TGA; 2019 [cited 2023 Jun 2].

Available from: https://www.tga. gov. au/sites/default/files/ausparsemaglutide-201030-pi.pdf

4. Therapeutic Goods Administration (TGA). Product safety [Internet]. About the Ozempic (semaglutide) shortage 2022 and 2023; 2023 [cited 2023 Jun 2]. Available from: https://www. tga.gov.au/ safety/shortages/informationabout-specific-shortages/aboutozempic-semaglutide-shortage2022-and-2023

5. Drug interactions: Glucagonlike peptide-1 analogues. 2023 [cited 2023 June 3]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https://amhonline. amh.net. au/interactions/glucagon-likepeptide-1-analogues-inter

Respiratory syncytial virus: a microorganism

Respiratory syncytial virus (RSV) is a negative sense, enveloped, singlestranded RNA virus belonging to the genus Orthopneumovirus of the family Pneumoviridae.1

RSV infects the airways and lungs and is a globally prevalent cause of lower respiratory tract infection. 2,3 It is the most common cause of acute lower respiratory tract infections in children.4 Almost all children will have been infected by RSV at least once by the age of three years. 5

RSV infection is a major public health issue. 2 Worldwide, RSV is estimated to cause 33 million lower respiratory tract illnesses, 3.2 million hospitalisations, and up to 118,000 childhood deaths.6,7

RSV causes seasonal epidemics.6 In temperate regions of Australia, RSV outbreaks follow a seasonal pattern typically occurring during autumn and winter.4,6 In northern parts of Australia RSV outbreaks generally correlate with rainfall and humidity patterns typically occurring during the rainy season from December to March.6

TRANSMISSION AND INFECTION

RSV is highly infectious. 5,8 It is transmitted by respiratory droplets produced when an infected person talks, coughs, or sneezes.1,7,9,10 RSV may also be transmitted through person-to-person contact or contact with contaminated items or surfaces, such as tissues, toys, and door handles. 5,9 RSV can survive for up to

seven hours on contaminated items and surfaces.8

After inoculation via the nose, mouth or eyes, RSV initially infects the airway epithelial cells in the upper respiratory tract.1,8,11 RSV rapidly spreads to the lower respiratory tract, reaching the bronchioles where viral replication is more effective.8,11

The primary cells targeted by RSV infection are the ciliated cells in the bronchial epithelia and type I pneumocytes in the alveolus.11

Viral shedding is highly variable. Shedding generally begins within a day of infection and generally correlates with the severity of the infection, age of the infected person, and whether the infected person is immunocompromised.

Adults typically will shed the virus for three to seven days, infants for up to 14 days in mild infections, and immunocompromised individuals for several months.11

SIGNS AND SYMPTOMS

The incubation period for RSV is two to eight days, but is most commonly five days.7,10

Common signs and symptoms of RSV infection include:5,10

• Rhinorrhoea (runny nose)

• Cough

• Fever

• Sneezing.

RSV may also cause wheezing and difficulty breathing, particularly in young children, and is commonly associated with ear infection. 5,9

While RSV usually causes mild respiratory illness, severe infections

and complications, such as pneumonia and bronchiolitis may develop in some cases. 5,7,9

Severe or life-threatening RSV infections and complications are more common in infants, older people, people with chronic heart or lung conditions, and people who are immunocompromised. 2,5,9

DIAGNOSIS

RSV infections are generally diagnosed by clinical assessment based on patient history and signs and symptoms. 5,9

Laboratory tests may be used to confirm a diagnosis of RSV.9 The most commonly used laboratory tests are:5,7

• Polymerase chain reaction (PCR) to detect the virus in nasopharyngeal aspirate or swabs

• Antigen testing to detect virus antigens in nasopharyngeal aspirate or swabs.

TREATMENT

There is no specific treatment for RSV infections.9 In most cases RSV infections are mild and self-limiting, and treatment is generally focused on symptom relief. 5,9

Symptoms can be managed with bed rest, with paracetamol, aspirin, or nonsteroidal anti-inflammatory drugs used to manage pain and fever. 5,9,10

However, aspirin should not be given to children under 12 unless specifically recommended by a doctor.10

Severely ill children and elderly patients may require hospitalisation and treatment with intravenous fluids and oxygen therapy. 5,10

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In Australia, RSV infection is a nationally notifiable disease. 3 Notification allows the geographic spread of infections to be monitored and informs disease prevention and control programs.12

PREVENTION

The most important preventive measure is good hygiene.9 Washing hands regularly with soap and water will significantly reduce the risk of infection. 5,9,10

Other preventive measures include:5,9,10

• Covering the nose and mouth when sneezing or coughing

• Immediately disposing of used tissues

• Not sharing glasses or eating utensils

• Regularly cleaning surfaces and items that may be contaminated with a household detergent.

Palivizumab may be given as a prophylaxis against RSV infection in infants at high risk of serious complications from RSV.13 It is effective in reducing hospitalisations and preventing serious lower respiratory tract infections in highrisk infants.13,14

Palivizumab is administered once a month during anticipated periods of RSV infection in the community. Prophylactic treatment should begin before the anticipated start of the RSV season.13

REFERENCES

1. Battles MB, McLellan JS. Respiratory syncytial virus entry and how to block it. Nat Rev Microbiol [Internet]. 2019 [cited 2023 May 16];17:233-245. doi: 10.1038/s41579-019-0149-x

2. Chuang Y, Lin K, Wang L, Yeh, T, Liu P. The Impact of the COVID-19 Pandemic on Respiratory Syncytial Virus Infection: A Narrative Review. Infect Drug

Resist [Internet]. 2023 [cited 2023 May 16];16:661-675. doi: 10.2147/idr. s396434

3. Australian Government Department of Health and Aged Care. Diseases [Internet]. Respiratory syncytial virus (RSV) infection; 2022 [cited 2023 May 18]. Available from: https:// www.health.gov.au/diseases/ respiratory-syncytial-virus-rsvinfection

4. Foley DA, Phuong LK, Peplinski J, Lim SM, Lee WH, Farhat A, et al. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child [Internet]. 2021 [cited 2023 May 16];0:1-7. doi: 10.1136/archdischild-2021-322507

5. NSW Government. NSW Health [Internet]. Respiratory syncytial virus (RSV) fact sheet; 2022 [cited 2023 May 20]. Available from: https://www.health.nsw.gov.au/ Infectious/factsheets/Pages/ respiratory-syncytial-virus.aspx

6. Eden JS, Sikazwe C, Xie R, Deng Y, Sullivan SG, Michie A, et al. Off-season RSV epidemics in Australia after easing of COVID-19 restrictions. Nat Commun [Internet]. 2022 [cited 2023 May 18];13:2284. doi: 10.1038/s41467022-30485-3

7. Jain H, Schweitzer JW, Justice NA. Respiratory Syncytial Virus Infection. 2022 [cited 2023 May 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK459215

8. Carvajal JJ, Avellaneda AM, Salazar-Ardiles C, Maya JE, Kalergis AM, Lay MK. Host Components Contributing to Respiratory Syncytial Virus Pathogenesis. Front Immunol [Internet]. 2019 [cited 2023 May 18];10. doi: 10.3389/

fimmu.2019.02152

9. Healthdirect Australia. Healthdirect [Internet]. Respiratory syncytial virus (RSV); 2022 [cited 2023 May 16]. Available from: https://www.healthdirect. gov.au/respiratory-syncytialvirus-rsv

10. Government of South Australia. SA Health [Internet]. Respiratory syncytial virus (RSV) infection –including symptoms, treatment and prevention; 2022 [cited 2023 May 18]. Available from: https:// www.sahealth.sa.gov.au/wps/ wcm/connect/public+content/ sa+health+internet/conditions/ infectious+diseases/piratory +syncytial+virus+rsv+infection

11. Kaler J, Hussain A, Patel K, Hernandes T, Ray S. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus [Internet]. 2023 [cited 2023 May 18];15(3): e36342. doi:10.7759/cureus.36342

12. Healthdirect Australia. Healthdirect [Internet]. Notification of illness and disease; Year [cited 2023 May 20]. Available from: https://www.healthdirect. gov.au/notification-of-illnessand-disease

13. Palivizumab. 2023 [cited 2023 May 20]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https:// amhonline.amh.net.au/chapters/ anti-infectives/antivirals/otherantivirals/palivizumab

14. Olchanski N, Hansen RN, Pope E, D’Cruz B, Fergie J, Goldstein M, et al. Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value. Open Forum Infect Dis [Internet]. 2018 [cited 2023 May 20];8(3):ofy031. doi: 10.1093/ ofid/ofy031

Peripherally inserted central catheter line dressings for paediatric patients: a clinical update

ANF iFOLIO CLINICAL UPDATE:

Peripherally inserted central catheter line dressings for paediatric patients: a clinical update

Read this article and complete the quiz to earn 1 iFolio hour

A peripherally inserted central catheter (PICC) line is a long-term central venous access device.1 It is a long, thin, flexible tube inserted through a vein in the upper arm and advanced until the tip is in the superior vena cava, ideally at the cavoatrial junction (see Illustration 1).1,2

A peripherally inserted central catheter (PICC) line is a long-term central venous access device.1 It is a long, thin, flexible tube inserted through a vein in the upper arm and advanced until the tip is in the superior vena cava, ideally at the cavoatrial junction (see Illustration 1).1,2

A PICC line is used to administer intravenous fluids, blood products, medications, and nutrition.1,3 It is used when treatment is required for more than 14 days and may remain in situ for up to six months.1,2

A PICC line is used to administer intravenous fluids, blood products, medications, and nutrition.1,3 It is used when treatment is required for more than 14 days and may remain in situ for up to six months.1,2

As PICC lines provide direct access to the bloodstream they are associated with a serious risk of infection from microorganisms introduced during insertion or while the device is in situ. 1,4 Central line associated blood stream infections are associated with prolonged hospital stays, and increased morbidity and mortality.1

As PICC lines provide direct access to the bloodstream they are associated with a serious risk of infection from microorganisms introduced during insertion or while the device is in situ.1,4

Following PICC line insertion a dressing is necessary to protect the insertion site from microorganisms. The incidence of microorganisms entering the blood stream through the insertion site can be reduced by a clean, dry, and intact dressing. 1

INITIAL DRESSING

Central line associated blood stream infections are associated with prolonged hospital stays, and increased morbidity and mortality.

Following PICC line insertion a dressing is necessary to protect the insertion site from microorganisms. The incidence of microorganisms entering the blood stream through the insertion site can be reduced by a clean, dry, and intact dressing.1

In paediatric patients, a sterile transparent semipermeable membrane (TSM) dressing should be used to cover the PICC line insertion site.1 These dressings reduce colonisation of bacteria as they are impermeable to microorganisms but are semipermeable to oxygen, carbon dioxide, and water vapour.1,4 They also facilitate visualisation of the PICC line site. 1

If the insertion site is bleeding or leaking exudate, or if excessive sweating occurs, a sterile gauze dressing may be preferred to absorb the fluid until the situation resolves. The gauze dressing should be replaced with a TSM dressing as soon as possible after the insertion site becomes dry.1

DRESSING CHANGES

INITIAL DRESSING

The PICC line dressing should be changed at regular and established intervals to ensure it remains in an optimal functioning condition.1

In paediatric patients, a sterile transparent semipermeable membrane (TSM) dressing should be used to cover the PICC line insertion site.1

Transparent semipermeable membrane dressings should be changed every five to seven days.1,4 Gauze dressings, if used due to a bleeding or leaking insertion site or profuse sweating, should be changed every 24-48 hours.1

These dressings reduce colonisation of bacteria as they are impermeable to microorganisms but are semipermeable to oxygen, carbon dioxide, and water vapour.1,4 They also facilitate visualisation of the PICC line site.1

The PICC line dressing should be changed immediately if its integrity becomes compromised, such as by moisture, it becomes loose, or there are signs of infection at the insertion site, such redness, exudate, or pain.1

Equipment

If the insertion site is bleeding or leaking exudate, or if excessive sweating occurs, a sterile gauze dressing may be preferred to absorb the fluid until the situation resolves.

Changing PICC line dressings is an aseptic procedure and appropriate personal protective equipment and sterile equipment are required.1,4 Equipment for a routine PICC line dressing change is: 4

The gauze dressing should be replaced with a TSM dressing as soon as possible after the insertion site becomes dry.

• Sterile dressing pack

• Plastic backed protector sheet

• Non-sterile gloves

• Sterile gloves

DRESSING CHANGES

• 2% chlorhexidine in 70% alcohol skin preparation, (povidone-iodine in alcohol can be used as an alternative if cases of hypersensitivity or allergic responses to chlorhexidine gluconate)

• Sterile water

The PICC line dressing should be changed at regular and established intervals to ensure it remains in an optimal functioning condition.

• Adhesive securement device, such as StatLock or GripLok

• Large TSM dressing, such as Tegaderm or Opsite IV 3000

• 10mL syringes (two)

• 10mL 0.9% normal saline (two)

Transparent semipermeable membrane dressings should be changed every five to seven days.1,4 Gauze dressings, if used due to a bleeding or leaking insertion site or profuse sweating, should be changed every 24-48 hours.

• 70% alcohol, or 2% chlorhexidine and 70% alcohol impregnated swabs for disinfecting connectors/bungs

• Connectors/bungs for each lumen.

Procedure

The PICC line dressing should be changed immediately if its integrity becomes compromised, such as by moisture, it becomes loose, or there are signs of infection at the insertion site, such redness, exudate, or pain.1

Before changing PICC line dressing, the procedure should be explained to the child, and their parent or carer.4 Consent to the procedure should be obtained. 1

Equipment

Changing PICC line dressings is an aseptic procedure and appropriate personal protective equipment and sterile equipment are required.1,4

The child, and their parent of carer, should be told they must remain still for the duration of the procedure.1,4

An assessment of patient compliance should be conducted, and if the child is disorientated, confused, or

Line inserted into the arm and enters the brachial vein

Line travels down the superior vena cava into the cavoatrial junction Access

Equipment for a routine PICC line dressing change is:4

• Sterile dressing pack

• Plastic backed protector sheet

• Non-sterile gloves

• Sterile gloves

• 2% chlorhexidine in 70% alcohol skin preparation, (povidoneiodine in alcohol can be used as an alternative if cases of hypersensitivity or allergic responses to chlorhexidine gluconate)

• Sterile water

• Adhesive securement device, such as StatLock or GripLok

• Large TSM dressing, such as Tegaderm or Opsite IV 3000

• 10mL syringes (two)

• 10mL 0.9% normal saline (two)

• 70% alcohol, or 2% chlorhexidine and 70% alcohol impregnated swabs for disinfecting connectors/ bungs

• Connectors/bungs for each lumen.

Procedure

Before changing PICC line dressing, the procedure should be explained to the child, and their parent or carer.4

Consent to the procedure should be obtained.

The child, and their parent of carer, should be told they must remain still for the duration of the procedure.1,4

An assessment of patient compliance should be conducted, and if the child is disorientated, confused, or noncompliant additional assistance for the procedure should be sought.4

Preliminary steps 4

1. Perform hand hygiene and put on personal protective equipment (PPE) as required

2. Measure the external catheter length and compare it to the insertion measurement (a discrepancy of greater than 2cm should be reported for investigation of the PICC line tip location)

3. Assess the insertion site for any abnormalities, such as redness, swelling, exudate, tenderness, or pain (contact the treating medical team if there are any abnormal signs or symptoms)

Remove the existing dressing 1,4

1. Perform hand hygiene and put on non-sterile gloves

2. Open the dressing pack and sterile items using an aseptic technique

3. Position the child so the PICC line is easily accessible

4. Place a non-sterile blue plastic backed sheet under the child’s arm to protect clothing and bedding from skin preparation run-off

5. Gently remove the dressing by carefully rolling up the dressing edges, to reduce the risk of catheter dislodgement, while firmly holding the skin close to the edge of the dressing, to reduce the risk of tearing the skin

• Wetting around and underneath the dressing with 2% chlorhexidine in 70% alcohol swab sticks as the dressing is removed can assist removal and protect the skin by dissolving the adhesive

6. Gently remove the adhesive securement device in accordance with the manufacturer’s directions taking care not to dislodge or accidentally withdraw the PICC line

7. Remove gloves and discard waste.

Cleanse the insertion site and surrounding skin1,4

1. Perform a one-minute aseptic hand wash and put on sterile gloves

2. Inspect the insertion site for any redness, swelling, or exudate

3. Assess the surrounding skin for signs of medical adhesive related skin injury (MARSI)

4. If dry blood or organic matter is present on the skin or catheter, cleanse the skin or catheter with gauze soaked in sterile water moving from the insertion site outwards

5. Disinfect the insertion site and surrounding skin with a 2%chlorhexidine in 70% alcohol solution and a gauze swab from the dressing pack or a sterile 2% chlorhexidine in 70% alcohol swab, using a circular motion moving in concentric circles from the insertion site outwards

6. Allow the skin to air dry.

Apply the new adhesive securement device and dressing 1,4

1. Apply the adhesive securement device in accordance with the manufacturer’s instructions

2. Apply a large sterile TSM dressing positioned so the insertion site is in the centre of the dressing and the adhesive securement device is completely covered

3. Gently press the dressing to ensure firm skin contact

4. Label the dressing with the date the dressing change was performed or the date it is due to be changed.

A skin barrier solution can be applied prior to the applying the new adhesive securement device and dressing if the child is at risk of MARSI.

A gum mastic liquid adhesive can be considered for children who require enhanced adhesion, due to a bleeding or leaking insertion site or for profuse sweating. A skin barrier solution should be considered prior to using a liquid adhesive.1

Cleanse and replace connectors/ bungs 4

1. Prepare new connectors/bungs and prime them with 0.9% normal saline using a 10ml syringe, leaving the syringe attached

2. Disinfect each old connector/ bung with a separate swab or wipe (70%alcohol or 2% chlorhexidine in 70%alcohol) for 15 seconds

3. Remove the old connectors/bungs (if the PICC line is not valved clamp each lumen before removing connectors/bungs)

4. Disinfect the lumens with swabs (70%alcohol or 2% chlorhexidine in 70%alcohol) for 15 seconds and allow to air dry

5. Apply the new connectors/ bungs and flush the line with 0.9% sodium chloride or a suitable flushing solution using pulsatile technique.

Concluding steps 4

1. Cover the PICC line dressing with an appropriately sized elasticated viscose tubular bandage to protect the PICC line and external lumens and connectors/bungs

2. Remove gloves and discard waste

3. Perform hand hygiene

4. Measure the external catheter length and compare it to the predressing procedure measurement and the insertion measurement (a discrepancy of greater than 2cm should be reported for investigation of the PICC line tip location).

Documentation

The PICC line dressing change, clinical assessment of the insertion site, and external catheter measurement should be recorded in the child’s healthcare record according to local policies and procedures.1.4

REFERENCES

1. Agency for Clinical Innovation. Central venous access devices (CVAD) [Internet]. Sydney (Australia): Agency for Clinical Innovation; 2021 [cited 2023 May 12]. Available from: https://aci. health.nsw.gov.au/__data/assets/ pdf_ file/0010/239626/ACI-CVADclinical-practice-guide.pdf

2 The Royal Children’s Hospital Melbourne. Factsheets [Internet]. CVAD: Peripherally Inserted Central Catheter PICC; 2020 [cited 2023 May 12]. Available from: https://www.rch.org.au/kidsinfo/ fact_sheets/CVAD__Peripherally_ Insert-ed_Central_Catheter_PICC

3. Mayo Clinic. Mayo Clinic Health Information [Internet]. Peripherally inserted central catheter (PICC) line; 2021 [cited 2023 May 12]. Available from: https://www. mayoclinic.org/tests-procedures/ picc-line/about/pac-20468748

4. Government of South Australia. Clinical Guidelines [Internet]. Peripherally In-serted Central Catheter Cressing Man-agmeent Clinical Guideline; 2020 [cited 2023 May 12]. Available from: https://www.sahealth.sa.gov. au/wps/wcm/connect/ ba19850042c387a78165f78cd21c605e/PICC+Dressing+procedure+guideline+v1.0_27092017. p df ?MO D=A J PERES& CAC -HEID=ba19850042c387a78165f78cd21c605e

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1 Deadly virus spread through an animal bite(6)

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Across 1 Rabies, 5 Diet, 9 Twice, 10 Offal, 11 Chilli, 13 Lost, 15 Trio, 16 Astigmatism, 20 Ugly, 22 Clause, 24 Tarsi, 25 Asp, 27 Dislocate, 28 Niece, 30 Obese, 31 Embalm, 33 Unit, 35 Perspiration, 39 Teat, 41 Stow, 42 Pulses, 45 Emote, 46 Ennui, 47 Ever, 48 Cornea.

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