When she was an undergraduate nursing student, Monisha Lagreca worked on a mental health ward as part of the ANMF (Vic Branch) pioneered Registered Undergraduate Students of Nursing (RUSON) paid employment model.

Under the delegation and supervision of mental health nursing staff at Peninsula Health, she gained invaluable firsthand exposure to the specialty, which quickly convinced her it was the right career path for her.

“I was able to showcase my skills and prove my worth,” she recalled.

“If I didn’t have that experience, I think I would have struggled as a grad.”

Monisha shared her journey at the recent 2023 International Mental Health Nursing Conference, titled ‘Unleash the Potential’, alongside Jade Chandler, Mental Health Nursing Officer at the ANMF (Vic Branch), and Stuart Wall, Education Stream Lead (Mental Health and AOD) at Peninsula Health.

Ms Chandler traced over the history of the innovative RUSON model, introduced back in 2016, which involves second and third year registered undergraduate nursing students working in acute or subacute care, aged care, and more recently mental health, assisting nurses to provide patient care. The model has been proven to lead to numerous benefits such as timelier care and support for patients, and improved workload management for staff.

“They [RUSONs) cannot be the sole provider of care to patients or consumers,” Ms Chandler explained.

“They work as part of the care of the nursing team, assisting nurses and providing elements of nursing and patient care.”

Amid the unprecedented challenges of the COVID-19 pandemic, and a Royal Commission into Victoria’s Mental Health System, in 2021 Victoria looked into adapting its successful RUSON model for mental health, which falls under a distinct enterprise agreement. The ANMF (Vic Branch) worked with the Department of Health, and the Health and Community Services Union (HACSU), to roll out pilot programs across three mental health areas.

Some of the core duties RUSONs would carry out, adapted for mental health, included:

• Supporting care delivery relating to consumer activities of daily living.
• Assisting clients in taking part in therapy programs such as gardening, or community meetings.
• Responding to call bells.
• Directing visitors in the ward, and to members of staff who can answer their questions.
• Scheduling appointments.
• Observing handover and clinical reviews.
• Communicating or escalating issues of concern to the registered nurse.

The pilot program ran for 25-weeks, with most RUSONs completing between 10 and 40 shifts during the period. Evaluation of the program found all students were highly likely to pursue a specialised mental health graduate program.

“Participants felt passionate, curious, excited and eager in thinking about working with people with mental health conditions,” Ms Chandler said.

“[They] held positive attitudes towards mental health, consumers, families, and carers.”

The success of the initial pilot led to the state government injecting an extra $4 million to support the program to provide 100 RUSON positions, as well as 20 pre-qualified enrolled nurse positions, across all mental health services, including Peninsula Health.

Last year, the ANMF (Vic Branch) also negotiated to improve RUSON provisions within the latest mental health enterprise agreement outlining the program, including limiting the number of RUSONs who can work per shift on each ward, and RUSONs not being placed on high dependency or intensive care units.

Addressing delegates at the conference, Stuart Wall said Peninsula Health first tapped into the RUSON model in 2019, before expanding it to mental health in 2021 when the COVID-19 pandemic hit. After adapting the model for mental health, and ironing out concerns over scope of practice, staff quickly realised its far-reaching value.

“It seemed a little bit like a no brainer,” Mr Wall said.

“Having people coming into mental health as nurses and seeing what it was like, even though they weren’t nurses yet, but they were studying to be nurses. It provided them with this feeling of comfort, support, and insight into the way that we worked within these environments that they may not have had access to [otherwise].”

“They do [clinical] placements, they do subjects at university. But that’s a very different thing to being part of a workforce, being part of a team. And when you’re doing your shift a week, or two shifts a week, in a team that’s pumping you up, they’re getting you to do things, they’re getting to know you, they’re seeing the value that you add…it makes a real difference.”

The success of the program is easy to see, Stuart argues, with all student nurses who undertook the RUSON program going on to secure graduate or post-graduate positions working within the mental health unit.

It’s a path that Monisha, who completed her graduate year at Peninsula Health, before securing a full-time position on the mental health ward, also followed.

“After completing my grad year, I decided to continue as a mental health nurse as I enjoyed the one-on-one interaction with patients, developing the rapport, and offering them emotional support, as opposed to the impersonal, often task-oriented, and physically draining work that I experienced on the surgical ward.”

Within four weeks of starting full-time on the mental health ward, Monisha was already offered a role as one of the nurses in charge.

She counts being exposed to the ward environment and the specific clinical skills required to successfully work on a mental health ward among the biggest benefits of the RUSON model. The experience wasn’t without its challenges, of course, and while exposure to aggressive patients presented a real eye-opener, the de-escalation techniques she learned from more seasoned colleagues allowed her to cope.

“I was very fortunate [as] I had really awesome clinical educators,” Monisha said.

“They were my go-to-people, and they caught up with me on a regular basis on the ward to discuss how I was going and if I needed any help. I was also offered ward training, the same as what staff members were receiving, for things like risk management, de-escalation, dealing with conflict, [and] medication management, which was very useful.”

Stuart said that when he first started working at Peninsula Health, the question people would ask him the most was why the RUSON program wasn’t a part of mental health. Now, after safely and successfully integrating it, and seeing the benefits it brings for both patients and staff, the narrative has shifted to how it can be supported even more.