Mrs. Loughman works in a busy suburban emergency room (ER) as a geriatric clinical nurse specialist (GCNS). She has a master's degree in medical-surgical nursing. She has been in this position for three and a half years. Generally, forty thousand patients are seen in this ER with 30% composed of people 65 and older. As this ER is associated with a Health Maintenance Organization (HMO) all of the health care recipients are insured. Thus, the poor and very poor are not part of this nurse's population and less than 2% consist of any ethnic mix. The ER cares for medical and surgical emergencies and 20% non-emergent problems.
             Education is a large of part of Mrs. Loughman' s role. She educates client and family, nursing personnel and ER staff and teaches in the community as well. Her practice is limited to those home-going elders, 65 and older. A good part of her care stems from her assessment of the client and family. Her assessment is comprehensive using a theoretical nursing framework. She does not do any "hands-on" care such as the technical duties often now considered nursing. Yet, she often provides caring touch, a warm blanket, hot coffee or a back rub to soothe a patient or family member. She says Florence Nightingale's intent was really to have nurse's do health care thinking. Mrs. Loughman says " I get paid for my brains, I assess, plan, implement and evaluate the patients plan of care without listening to the patients heart, I listen to their inner- heart"!
             She is important to the emergency room because she can sort out the causative problem for why the older client ended up in the ER this action alone saves time and healthcare dollars Her role is focused on health promotion and disease prevention. She has stated that a fall for an elderly person is only the tip of the iceberg.
             Often many of the patients in the ER are all referrals to the GCNS....