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metropolitan hospital, would be referred or dealt with by another ‘specialist’ clinician. Some commentators prefer to use the other term ‘advanced practice’ (Hegney, 1997, National Rural Health Alliance, 2005) but the same notion is involved. In the absence of mental health personnel, possession of mental health nursing skills by remote general nurses is necessary to avoid poor outcomes. One difficulty of remote nursing is that many high acuity skills, including mental health, are required infrequently (Hanna, 2001; Hegney et al., 1997). This limits both the development and maintenance of expertise, and accordingly, confidence to perform them. An answer to the degradation or erosion of skills (including mental health) for remote nurses is training, which is a problematic issue in itself (Ellis & Philip, 2010). 9.4.2 Resilience Resilience is the capacity to recover quickly from difficulties (Shorter Dictionary, 2007) and an ability to rise above difficult situations (Criss, Pettit, Bates, Dodge & Lapp, 2002). The remote nurse’s social world is one of constant difficulties and challenges. It is the ability and tenacity of remote nurses to recover from them and to continue functioning (Tusaie & Dyer, 2004) in the social world, which is a key finding of this study. At the core of resilience is the notion of supporting a nurse’s strengths and functionally coping (Edward, 2005). Importantly Bonanno (2004) notes that resilience, involves maintenance of equilibrium, with no loss of normal functioning; it is not recovery. Lazarus and Folkman (1984) define coping as ‘constantly changing cognitive and behavioural efforts to manage specific internal/external demands that are appraised as exceeding the resources of the person’ (p. 141). Two dimensions of coping are problem focused coping and emotion-focused coping (LeSergent & Haney, 2005). Problem-focused