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the remote nurse’s social world, and therefore present in the healthcare arena, the first network would be created between them and the remote nurses. The mental health patient’s presentation immediately causes the remote nurses group to respond through engagement. The manner, level and type of engagement, and hence the nature of the network, again is predicated on the mental health patient’s presentation. If the mental health patient simply presents for a routine psychiatric ‘depot’ injection, then the network is momentary in existence. If, however, the mental health patient’s presentation is floridly psychotic with genuine and high risk elements of self-harm and suicide, then such a network would obviously be insufficient to deliver the appropriate mental healthcare. A new and larger network of actors would be created. The mental health patient shapes the groups and network response(s) and vice versa. Accordingly, remote nurses do not have fixed or rigid goals, strategies or preferences but instead construct them locally in the course of interaction and negotiation with all actors, particularly the mental health patient (Friedberg, 1993). Hence the remote nurse’s social world is never in a state of stability, but is ever responding to changes in circumstances bringing into play differing levels of interactions with and within networks. The remote nurse has to align his or her response to a mental health patient according to the presentation and resources available, all of which are highly unpredictable and variable; for example, available staff, type of mental health presentation and availability of other groups within the social world can all vary. This adds to the remote nurse’s lack of ability to plan, predict and materialise resources. Correspondingly, this increases the complexities of issues, levels of stress and workplace pressure for remote nurses. Resultantly, remote nurses delivering mental healthcare have to adopt malleable goals, changing preferences