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Eley, Parker, Tuckett & Hegney, 2009) which creates challenges and the need for a diverse knowledge and skill set (Weymouth et al., 2007; Cramer, 2006). While nurses working in rural and remote settings reported feeling isolated and insufficiently-resourced to care for people with mental health needs, this feeling was not confined or unique to rural and remote nurses; generalist nurses caring for mental clients irrespective of location reported similar feelings (Bailey, 1998; Haddad et al., 2005; Lethoba, Netswera & Rankhumise, 2006; Mavundla, 2000; Reed & Fitzgerald, 2005). Findings from this literature review, and from studies in other settings (Bailey, 1998; Brinn, 2000; Fleming & Szmukler, 1992; Gillette et al., 1996; Muirhead & Tilley, 1995; Sharrock & Happell, 2002; Wand & Happell, 2001), indicate that generalist nurses perceive themselves as lacking knowledge, skills and confidence to competently assess and manage mental health clients. Wynaden, O’Connell, McGowan and Popescu (2000) whose study involved 241 nurses from 43 health services in Western Australia reported a lack of confidence in caring for a person with mental illness (58%), while 62% of respondents felt they did not have adequate and relevant knowledge and skills. This perception of being under-qualified to care for clients with a mental illness results in reduced work satisfaction for nurses and leads them to question their ‘role(s)’ (Owen, Tennant, Jessie, Jones & Rutherford, 1999). In the literature included in this integrative review, rural and remote nurses consistently asked for more training and up-skilling to address their self-reported lack of knowledge and skill in mental health nursing. Clark et al. (2005), citing Shaw, Cartwright, Spratley and Harwin (1978), linked the lack of knowledge to other negative feelings and anxieties about role adequacy and role support which in turn causes role insecurity or low levels of therapeutic commitment: a vicious compounding cycle of negativity. This