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metropolitan hospitals reported higher levels of psychological distress than nurses working remotely, although the difference was not statistically significant. Nurses working in metropolitan hospitals did however demonstrate significantly higher levels of emotional exhaustion compared to remote nurses. A reason for this study’s findings is that for the five reasons outlined above, remote nurses are more resilient than those in metropolitan areas. This is again consistent with a study comparing stress levels between rural nurses and metropolitan hospital based nurses (Albion, Fogarty & Machin, 2005). 9.4.3 Responsiveness Responsiveness is the quality of reacting quickly and positively to a situation or challenge ( Shorter Oxford Dictionary , 2007). The complexity and variability of mental health presentations means a level of agility and responsiveness to meet the challenges of mental health presentations. Unlike a medical presentation involving a rational patient or a medical condition which is self-evident, such as laceration presentation, mental health presentations may not be so straight forward. The patient may be attending against their will, may not believe they have a mental illness or may be psychotic and unable to be reasoned with. In these situations the patient may be violent, abusive, uncontrollable, uncooperative or unpredictable. Accordingly remote nurses have to react quickly and decisively in containing the situation with the limited resources at hand. Remote nurses’ responsiveness entails being available to deliver healthcare 24 hours a day, 7 days a week (Stewart et al., 2011). ‘[T]heir [remote nurses] working day is not contained in working hours’ (Mills et al., 2010, p. 34). While the primary healthcare centre may be closed, the nurse(s) either make themselves available, if they are a single person post or are rostered on overnight and over weekends, if there is more than one nurse