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RMO Orientation
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Starting on D4 · Gosford Hospital

Your first week as the
Paediatric RMO.

Everything you need to hit the ground running on the D4 paediatric ward - where to be, what the shifts look like, and the day-to-day jobs that make you useful from day one.

Ward: D4, Gosford Pager: 19304 Handover: 0800 · Lorraine Love Room Referral centres: CHW, SCH, JHCH
Calling for help in an emergency

You are never expected to manage an emergency alone - escalate early, it is always the right call.

First, call your team
  1. Call the registrar - your first call for any concern.
  2. Call the consultant on call for more senior input.
For immediate assistance
  1. Call 2222 and specify "neonatal emergency" or "paediatric emergency" so the right team comes.
  2. If you need more help, call 2222 and ask for "advanced neonatal resuscitation" - this also brings a nurse from the SCN.
Find your feet

Where everything is

D4 is the paediatric ward and your home base. The neonatal and obstetric areas are nearby - you'll get called to them on evenings and nights.

Paediatric ward
D4Main entrance → turn left → follow the corridor → look for the colourful stickers on your left.
Birth suite
K5Instrumental & emergency births.
Maternity
J7Postnatal reviews.
Special Care Nursery
K7Level 4 SCN. Covered by the SRMO; you may be called overnight.
Theatres
Level 5Follow the registrar! A scrub cap + long theatre jacket worn backwards usually does - full scrubs not always needed.
Tertiary referral
CHW / SCH or JHHChildren's Hospital Westmead, Sydney Children's Hospital, or John Hunter Hospital - which site depends on the specialty and the patient's address.
The roster

Your shifts

Paediatrics runs 24-hour RMO cover, so you should always be able to hand jobs over rather than stay back. If you do stay late, claim your overtime via UROC on Stafflink.

Day
0800 - 1830 (1800 weekends)

Ward round, jobs, discharges and consults. Keep the handover sheet rolling.

Evening
1400 - 0000

Not always rostered. Take handover from the day RMO, mop up outstanding jobs and PM reviews, and make sure the day RMO gets home on time.

Night
2300 - 0900

Just you and the registrar, covering ED, D4, deliveries (K5/theatres) and SCN (K7). A great chance to step up when things get busy.

Don't forget to hand over the pager (19304) at the end of every shift. We've all done that once.
Who you'll work with

The team

You're well supported here - there is always someone more senior to call, and the nursing staff are some of your most valuable colleagues.

SRMOs

Typically staff the Special Care Nursery and Paediatric Acute Review.

Registrars

There is always a registrar rostered with you. You work closely together, and they are very helpful and supportive - never hesitate to call them if you have any questions.

Fellows

Three fellow positions - Gosford hospital, Community, and Neonatal. At the moment only the Community and Neonatal fellow roles are filled.

Consultants

Eight consultants work at Gosford and are remarkably supportive - never hesitate to call. One is a dedicated wellbeing consultant who you will meet in your first couple of weeks.

Nursing staff

The paediatric and SCN nurses are extremely experienced. If they are worried, we are worried - and the same goes for parents. Always listen to them.

The day's rhythm

Handover & meetings

All three handovers happen in the same place - the Lorraine Love Education Room (enter D4, head to the back of the ward, door on your right).

0800 · Morning handover

Night → day team

The night RMO updates and prints ~4-5 copies of the running handover sheet (PR-02 printer, front reception room - colour) and "drives" PowerChart during handover.

Consultants will want to see the BTF chart, relevant results (pathology, imaging), progress/nursing/allied-health notes, and occasionally the Advanced Growth Chart.

Setting up the room

Computer & screen-share

  • Turn on the laptop, plug in the ClickShare button (USB dongle) and log in.
  • When it turns from red to white, click it to share your screen.
  • Open Citrix/PowerChart via the Intranet (the desktop shortcut doesn't work).
  • Join the D4 handover meeting on the tablet; hide the chat panel for a bigger screen.
  • Turn the laptop off when done so screen-sharing works for the next person.
The ClickShare button plugs into the laptop's USB port. The ring glows red, then turns white when it's ready - press it to share the screen.
1600 · Afternoon handover

Day → evening team

The day RMO updates the running sheet beforehand and prints copies for the evening team (usually fewer). Drive the computer as in the morning.

2000 · Night handover

Registrar to registrar

Informal handover in the doctor's room between the day and night registrars. Have the handover sheet updated with all expected patients included.

Running handover sheet (D4-Master-Handover.docx): Teams → GosfordPaediatric → General → Files → Handovers 2026. Most computers have it bookmarked.
Day to day

Your common jobs

The bread and butter of the RMO role. When in doubt on any of these - ask the registrar.

Ward round

Driving the COW (Daisy)

You document the morning round. Rounds can be quick, so ask if a plan isn't clear. Always note who was present (e.g. "seen with mum") and document relevant conversations.

Daisy should be stocked with tongue depressors, an otoscope and ear probes. The red ward folder holds fact sheets, Ventolin weaning plans and Asthma Action Plans.

eMR templates

Make them your own

Copy templates from previous paediatric RMOs for admission notes, ward-round notes and discharge summaries.

Do not use adult discharge templates - they carry pre-entered adult analgesia dosing (paracetamol, ibuprofen, oxycodone, etc.).
Discharges

Quick turnaround, no lounge

Turnaround is fast and there's no discharge lounge, so most parents won't wait for a summary. Fact sheets, Ventolin weaning plans and Asthma Action Plans live in the red folder on Daisy (the COW), which is full of useful info - discharges are a team effort, and the nursing staff are a fabulous resource.

Add any outstanding discharges or results-to-chase to the handover sheet.

Discharge meds

The D4 pharmacist

A wealth of knowledge who prepares discharge meds in the background - often before you ask. You don't need to give the pharmacist a med rec as on the adult ward, but complete one for the discharge summary as a record of dispensed meds.

Consults

Usually a call to CHW

Check with the team which referral site they'd like to use - some prefer JHCH or SCH, especially given the patient's address. CHW don't have eMR but may ask for an MRN to access imaging. Call via switch (43 → ask for Westmead Children's → say you're from Gosford paediatrics and name the team). Document clearly, including who you spoke to.

Evenings & nights

With the registrar

  • ED reviews and after-hours ward admissions.
  • Birth suite / theatres (instrumental births, emergency caesareans).
  • Paediatric & neonatal emergency calls.
  • Practise venepuncture / cannulation - flag your interest early!
Get it right

Charting & fluids

Everything is charted by weight. Double-check the patient's current weight in eMR before charting anything, and double-check dosing on AMH Children's even for drugs you've charted a hundred times.

Fluids

Use the Paediatric IV Fluids PowerPlan

There's a fluid-calc poster by the JMO computer in the doctor's room. The PowerPlan auto-calculates full maintenance from the latest eMR weight (and includes a TKVO line). Always sanity-check with an online calculator (e.g. RCH).

RuleHow
4 / 2 / 1 (mL/hr)4×first 10kg + 2×next 10kg + 1×rest
100 / 50 / 20 (mL/day)100×first 10kg + 50×next 10kg + 20×rest ÷ 24
2/3 maintenance is the most common order (meningitis / LRTI / bronchiolitis - SIADH risk). The PowerPlan gives full maintenance, so you'll need to calculate ⅔ manually.
What fluid?

By age

Day 110% glucose
Days 2-2810% glucose and 0.22% sodium chloride OR 10% glucose and 0.45% sodium chloride
Days 28+0.9% NaCl + 5% glucose
16-year-oldCounts as an adult - 0.9% NaCl is fine

Most ward kids get glucose 5% + sodium chloride 0.9%, with rare exceptions.

Medications

The usual suspects

  • Panadol & Nurofen: by weight, usually PRN. Avoid Nurofen in AKI.
  • Antibiotics: chart as per consultant/registrar; always clarify duration, especially on discharge. Check dosing on AMH Children's (ETG is great for antibiotics).
  • Xylocaine viscous: often for sore throat / tonsillitis to encourage PO intake - note the two dosing lines (<3 years and 3-12 years).

Check doses on AMH Children's Dosing Companion (bookmarked, or CIAP → Medications → AMH Children's).

Onward care

Referrals & follow-up

Every referral you send must be documented in PowerChart - these jobs often happen after discharge and are easy to lose track of.

Gosford PARC

Paediatric Acute Review Clinic

Type PARC into eMR. For a discharged patient, be on their inpatient encounter or PARC won't receive the referral. Specify F2F or phone follow-up; put a target date in the order comments and a brief reason (e.g. "day 5 bronchiolitis - review symptoms and feeding").

Wyong PAU

Paediatric Assessment Unit

Also an eMR order (search "PAU"). Generally for patients who came through Wyong ED or live closer to Wyong. For an in-person review, call PAU to let them know the patient is coming.

E4 clinic

Public paediatric clinic

Email cclhd-e4paediatrics@health.nsw.gov.au.

Subspecialty

ConsultMed (SCHN)

Subspecialty referrals most often go to the Children's Hospital at Westmead (CHW), but we also refer to Sydney Children's Hospital and John Hunter Children's Hospital depending on the specialty. SCHN referrals (CHW and SCH) go online via ConsultMed - you'll need an account. JHCH need written referrals - most can be emailed to 49223904@fax.hnehealth.nsw.gov.au. Example referral letters are saved on the JMO computer. In doubt, ask the registrar.

Learning

Teaching schedule

Protected teaching most weeks, on MS Teams and in the D4 handover room.

Monday · 1400-1500

Case presentation

A registrar/SRMO presents a case with consultants present. Currently on hold - expected to recommence in registrar term 3.

Thursday · 0830-0930

General paediatrics topic

A SRMO/registrar presents a general paediatric topic (e.g. DDH). Every second month this is replaced by the combined Paediatric/ED teaching program in ED.

M&M meetings

Morbidity & mortality

  • Neonatal: odd months, Wed 0830-0930, J7 meeting room.
  • Paediatric: even months, Wed 0830-0930, Lorraine Love Room.
  • Combined O&G perinatal: monthly, Tue 0730-0830, J7.
Coming soon

Watch this space

Exciting education opportunities coming soon.

What you'll see

Common conditions on D4

The everyday presentations. For the neonatal side, the rest of this hub has the pathophysiology and management in depth.

Respiratory

The big one

Bronchiolitis, viral-induced wheeze, asthma, pneumonia, croup. Use the Paediatric Acute Asthma Management PowerPlan (search "asthma" in eOrders) - it splits meds by severity and includes a salbutamol-stretching order.

Other common

Day to day

  • Febrile convulsions
  • Non-specific viral illness (e.g. gastroenteritis)
  • UTIs
  • T1DM - ongoing management or DKA
Go deeper

Neonatal systems

The respiratory system is fully built out on the hub - RDS, MAS, TTN, PPHN, air leak, CDH and apnoea, with pathophysiology, clinical findings and management.

Explore respiratory →

Back to the Neonatal Learning Hub

Recognise, reason and manage - the newborn, system by system, with the evidence behind it.

Go to the hub Browse systems
With thanks

Made with help from the team

This orientation was put together with a current paediatric RMO, so it reflects how the job really feels from day one.

Illustrated portrait of Dr Mia Negline

Dr Mia Negline

Big thanks to Mia, one of the 2026 paediatric RMOs, who generously shared how the role really works - the rhythm of the ward, the jobs that matter most, and the small things that make your first weeks easier. Much of this page is built on her experience.

"Ask early and ask often - no one expects you to know everything in your first week. The registrars and nurses genuinely want you to call, and you will learn the fastest by getting stuck in."

- Mia, on surviving your first week