S.TRUEMAN PhD THESIS 2016

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privacy, particularly when off duty (Manahan & Lavoie, 2008). This lack of anonymity is not generated by remote nurses being overtly social (although it can be an unintended factor of normal social interaction), but fundamentally occurs because of the everyday logistical contact and familiarity produced by everyday living in a small, isolated community (Paliadelis et al., 2012; Rosenthal, Zaslavsky & Newhouse, 2005). A quintessential example is where nursing accommodation is situated adjacent to the primary healthcare centre, or where the nurse’s residence is embedded in the community and is identifiable by the clearly labelled primary healthcare centre vehicle parked in the driveway. These circumstances can lead to issues of work–life balance (Buchan, 2012) and a perception of always being ‘on call’ (Stewart et al., 2011), both of which have negative impacts. All of the above issues are factors that negatively affect levels of recruitment and retention of remote nursing staff (Hegney et al., 2002). High levels of staff turnover make it difficult to cultivate and maintain collaborative remote work teams or environments for delivery of care, including mental healthcare (Hayes et al., 2012), as does greater reliance on staff on short-term contracts, who are less engaged in initiatives of ongoing quality improvement in healthcare (Busbridge & Smith, 2015). Research is clear that staff turnover is counterproductive to staff stability, and hence negatively affects health outcomes (Hickey et al., 2005). Staff turnover reduces the quality of healthcare (Bar-Zeev, Kruske, Barclay, Bar-Zeev & Kildea, 2013; Bar-Zeev, Barclay, Kruske & Kildea, 2013), and is consistent with strong anecdotal evidence that the effectiveness of primary health clinics is reduced (Wakerman et al., 2012). While FIFO models of delivery in nursing are becoming common practice (Morris, 2012) in response to recruitment shortages and low retention