S.TRUEMAN PhD THESIS 2016

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(Hegney, 1996). After hour call outs are a unique aspect of working remotely, and an integral part of being responsive to the demands for remote mental health services (Heidelbeer & Carson, 2013). Remote nurses assuming after hours on call can experience negative consequences, particularly in single postings. Many nursing commentators advocate for the closure of these primary health centres to ensure occupational health and safety regulations are complied with (Australian Nursing Federation, 2004; McCullough et al., 2012; Yuginovich & Hinspeter, 2007). Nurses themselves feel unsafe in such postings (Yuginovich & Hinspeter, 2007). Many rural [and remote] nurses: particularly in small communities, feel they are never off duty (Sturmey & Edwards, 1991). ‘“[O]n call” is continuous and work hours are extended according to the care needs of clients … to be done after hours. In the remote area where work, home, and social life overlap together in one place, nurses feel that they are ‘always on duty’’ (Cramer, 2006, p. 198). For some, the remote nurse’s missionary zeal makes it difficult for them to ‘draw the line’ between work and non-work, which in turn leads to workforce issues such as stress (Opie et al., 2010) fatigue and burnout (Cramer, 2006). Hence, while responsiveness in the remote nursing workforce is admirable and a virtue (and an absolutely necessary ingredient to the continuation of delivering remote healthcare, including mental health) there exists a down-side individuals. Yet remote general nurses continue to defiantly shoulder this burden. The crux of this issue is that without remote general nurses there would be no mental healthcare. Without their self-sacrifice, in being responsive to mental presentations there would be severely limited services. To maintain the present level of delivery, the cost and sacrifice is borne by remote nurses, as the only group in the healthcare system arena