Guideposts direct the way. When we are driving the destination is a location and we rely on the guidepost placed by others to get us to where we are going. We trust the guidepost is correct in its direction.

Guideposts in a social context are people in which we place our trust. Parents, teachers, mentors, leaders, and loved ones can be seen as guideposts we trust to show us a way that works. Understanding the construction of these guideposts in not necessary. As rational beings we are still responsible for the choices we make to follow or not follow their direction.

In my nursing practice my guideposts are few but have remained steady for 40 years.

The first I became aware of in nursing school and it merely, at the time. reinforced the work ethic of my family. It can best be said as the inscription over one of the Benedictine College’s buildings: Ora et labora (“Pray and work!”).

The second I learned in nursing school and put in practice each day I did my nursing work: I am the patient’s advocate and speak for them when they cannot.

The third became clear to me during my first job, fresh from nursing school and so bursting with knowledge I just wanted to show everyone I knew how to do nursing stuff: I know very little and have a lot to learn.

The fourth also became clear to me one night at that first job as a graduate nurse: Suffering is a strong part of life and death comes to us all.

The fifth guidepost arrived while I was working in an isolation SICU tucked away in a six bed ward that always smelled of MRSA: Each time I take the time to wash my hands and keep my practice clean I do not add to my patient’s burden of infection and do not pass it on to others.

The sixth I learned when I changed my nursing profession from critical care to the operating room: Maintaining a consciousness of what is sterile helps my patient.

The seventh became clear to me as I dealt with my own cancer diagnosis and simultaneously worked to complete my MSN: Find the important work the patient needs to do so the healing happens.

The next 40 years I came back to these guideposts demonstrated by loved ones, teachers, leaders, and other nurses, testing them again and again for veracity in different circumstances, places and times.

Through hourly, daily, weekly, yearly and lifelong practice they have imbedded themselves in my unconscious and become habit. I have put forth the effort to make them so in an infintestimal way each time I care for my patient, interact with a co-worker, or push back on a bad practice.

This has made me feel like a rule follower at times. In a weak moment just wanting to give in for the sake of convenience or avoidance of conflict.

I have been called names, been looked over for projects, and accomplished little promotion in terms of position or salary. On the flip side I have built strong, directional guideposts that serve me and my patients to this day. I am content that I have done the best work I could do when I was called upon to do it.

But the work is not done, it is never done. I will continue to evaluate my guideposts and build new ones as needed. My particular brand of caring depends upon them.

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