Mental health RUSONs: future proofing the mental health nursing workforce

‘If I’d had [a RUSON program] when I was an undergraduate, I would have come across into mental health sooner.’

As the mental health education stream lead at Peninsula Health, Stuart Wall could not be more enthusiastic about the service’s mental health registered undergraduate student of nursing (RUSON) pilot program. Operating since 2021, the program is an extension of the general nursing RUSON employment model first rolled out into select Victorian services in 2016, and becoming widespread during the pandemic.

At the 2023 International Mental Health Nursing Conference held in Melbourne in September, Stuart was joined by former mental health RUSON Monisha Lagreca and ANMF (Vic Branch) mental health nursing officers Jade Chandler and Jacinta Crofton (acting) to discuss the program and its successes at Peninsula Health.

The right time for mental health RUSONs

Giving an overview of the model, Jade told audience members that the Victorian Public Mental Health EBA has had a provision for a student employment model since 2012 (originally called PQRNs, for pre-qualified registered nurses), but it has been underutilised and inconsistently applied. ‘The clause in the agreement only basically outlined the pay rates, that they had to be enrolled in a course of study leading to be a nurse, and that the employer wasn’t obligated to run the program,’ she said.

The success of the RUSON and RUSOM model in general nursing and midwifery, the onset of the pandemic, and the Royal Commission into Victoria’s Mental Health System interim report recommendations – including to increase the graduate nurse numbers – meant the timing was right to adapt the RUSON model for mental health nursing.

ANMF (Vic Branch) worked with the Department of Health, the Health and Community Services Union (HACSU), lived experience members and others to run a pilot program across three area mental health services. Some of the core duties that were adapted for mental health included:

• supporting care delivery relating to consumer activities of daily living
• assisting clients with their participation in therapy programs, such as gardening or community meetings
• ensuring consumers have clean linen to assist them in making their beds if needed
• responding to call bells
• directing visitors in the ward environment, and to the member of staff who can answer their questions
• scheduling appointments
• observing handover and clinical reviews
• communicating or escalating issues of concerns to the registered nurse

The pilot program ran for 25 weeks, with most participating mental health RUSONS completing between 10 and 40 shifts in that time. In their post-program evaluations, all of them said they were passionate, curious, excited and eager when thinking about working with people with mental health conditions, and likely to pursue a specialised mental health graduate program.

The success of this initial pilot was followed up with an expansion of funding from the Andrews Labor government, with over $4 million to accommodate 100 RUSON positions as well as 20 pre-qualified enrolled nurse positions rolled out to all area mental health services that applied – among them, Peninsula Health.

This success saw the Branch negotiate improved RUSON provisions in the most recent mental health EBA, including:

• limiting to one the number of RUSONs who can work on a ward per shift, to safeguard agreed minimum staffing numbers
• RUSONs to work not less than four hours, not more than eight hours, Monday to Sunday; no night shift
• RUSONs not to be placed in high dependency unit or intensive care area
• work as RUSON is to count as continuity of service when they become an RN as long as there’s not a gap longer than 12 months.

‘It seemed obvious…’

Speaking to his experience of the model as an educator, Stuart explained Peninsula Health began its general RUSON program in about 2019, before expanding it to mental health in 2022.

‘It seemed obvious…,’ he said. ‘Having students coming into mental health and seeing what it was like provided them with this feeling of comfort, support and insight into the way that we worked within these environments that they may not otherwise have had access to.’

The result was ‘a pretty amazing experience’, he added. ‘Almost all of our people who started as RUSONs are now working with us as a grad or a postgrad, so that’s a real value add for us, and I’d like to see more of that. It’s a program that we can really see has the opportunity to build a strong pathway into nursing, and into mental health nursing.’

Monisha Lagreca is one such RN now working on the unit, and starting to act in charge. She attributes her confidence to do this to the experience she gained as a RUSON. ‘If I didn’t have that experience, I think I would have struggled as a grad,’ she said.

Among the other benefits of working as mental health RUSON, she lists:

• gaining firsthand exposure to the ward environment
• exposure to specific clinical skills you would use on the mental health ward, and exposure to ward processes and procedures
• gaining knowledge of how to approach challenging situations within Mental Health
• forming solid connections with, and being accepted as part of, the team
• gaining confidence in her clinical skills and as a professional.

There were challenges, among them being exposed to real world situations and talking about the scope of this new role with other nurses. This provided the opportunity to learn, for both Monisha and for the RNs adapting to a relatively new model of care.

The experience was an overall positive for Monisha. ‘I decided to continue as a mental health nurse,’ she says, ‘as I enjoyed the one-on-one time with patients, developing the rapport and offering them emotional support.’

It’s been an overall positive for Peninsula Health as well. ‘From the time that the general RUSON program started at Peninsula,’ Stuart said, ‘people kept saying to us: “why don’t we have RUSONs in mental health? We really need RUSONs in mental health.” Everyone saw the value in such a program.

There’s still so much more to do, he concludes, but the RUSON employment model is a step in the right direction.