What We Wish We Knew

John: When I was 22, I got married for the first time, and wish someone would have told me that I was not emotionally ready to handle that level of commitment to another person. Sex, yes. Commitment no. When I was 24, my son was born, and I wish that I was less focused on me and more on raising him right, so he could’ve benefitted from my tutelage. At 25, I wish I would have cared less about what everyone thought about me, and focused more about what I thought about myself. I could’ve been happier. All of us have the tendency to be Monday Morning Quarterbacks, and look back on history with rose-colored glasses. The truth is, you are exactly where you are supposed to be right now because of all the decisions you made leading up to this point. Maybe I wrecked my first marriage, but I was able to grow from that, and have a pretty successful second one. Maybe I wrecked my relationship with my son, but I was able to repair it with him as he got older – and he was able to be where he is because his mom raised him. And let me say publicly, there was NO WAY I could have raised him as well as she did. She gets the credit. And maybe if I was less focused on what other people thought, I would not have been able to develop a ridiculously sick work ethic to work as hard as I can for what I want. Each year holds a few great lessons. The kinds that you must not miss, because you might not be able to recapture until two decades later. Damn sure pay attention.

Question for my three friends – what are the lessons you learned in your 20s that you didn’t catch until years later?

Jen: I have learned that increasing my overall knowledge ultimately multiplies how much I don’t know. I used to envision knowledge as something that is finite. Something that has a beginning, middle, and end. I was a card-carrying member of the “I’m a lifelong learner” club. By that I meant that I planned to learn everything there is to know about things that interest or are useful to me. For instance I would learn everything about drugs and the lifelong part would be learning about new drugs or new developments in the pharmacy world, etc. As I have grown in wisdom, not just knowledge, I have realized knowledge is infinite and ever-growing. Tackling certain subjects expands the mind and opens up more ’empty space’ to fill with new knowledge and ideas. I finally learned that there is a lot I don’t know, and that there will always be; and, moreover, that there will always be more that I don’t know than I do.

Molly: I am very thankful that social media did not exist in my 20s and that the lessons I learned at that time were not documented for all eternity! The biggest lesson that I learned in my 20s, but didn’t catch until later was that I do not have to drive full speed ahead all of the time. When I was 18 I had a plan for myself; go to college and graduate in 4 years, become a nurse, work for two years, and then get my masters degree as a nurse practitioner. I was on track until my first semester in my masters program, my mom was diagnosed with ovarian cancer. I dropped out of school to move home to take care of her. Without the family emergency, I most likely would have pushed ahead, despite not being happy on that particular path just for the sake of “not quitting”. To me quitting equated failing, even if it wasn’t the right fit. I made the same mistake again at the age of 30, when I thought it was a good idea to work full-time, with one year old twins, and started my masters degree again. Life intervened again, when I became pregnant with our third son and was put on bed-rest almost immediately. I was on the right path, I was taking on too much. I was fortunate to figure out that a more realistic approach was to work part-time while I went back to school and had three boys under three years old. You don’t always have to keep moving forward in order to get ahead, and sometimes quitting can be winning.

Trish: This is an interesting topic John. I think we all can look back to our 20s and wish we did things differently. I think about technology. How in my 20s, I got my very first mobile cell phone, my very own email address, and was thrilled to connect to the internet using a dial-up modem. How exciting those times were!!! Who would have known that all these years later we have super high-speed internet and super smart phones!! Looking back, I really wish that as new technology was introduced, that I would have been less excited and set a healthy distance in connectivity. I find that like most, I am too attached to technology and too “connected”. In my 20s I didn’t realize how much self-care I had because of the lack of total connectivity. I work today to find a healthy distance from technology to recharge my own batteries.

Originally Published on November 16, 2018 on LinkedIn

By John R. Nocero, Jennifer Rawley, Molly Downhour & Patricia Graham

Strength in Vulnerability

John:    If you have been told that showing vulnerability in the workplace is a sign of weakness, think again. All of us are vulnerable. None of us are immune. We may put up a false bravado to hide any sign of weakness, but your team sees right through it. One of the strongest work relationships I have ever had is because I was willing to show my vulnerability. We were working on a financial spreadsheet, and I kept pushing saying we have to finish by the specified deadline. She said, “Why are you pushing so hard?” I said “because this is the only thing I am good at. I suck at everything else. I suck at my marriage and I suck as a dad.” Because I was willing to show my weaknesses, she opened up and now we are amazing collaborators. But who knows what would have happened if I chose to stay within myself and refused to open up.


Question for my three friends: describe a time when you showed vulnerability and it was a sign of strength, and not weakness.


Jen:   In my college years and early career days, I would push forward with a “fake it til I make it” mentality. It was a false display of confidence to cover for lack of experience. More recently, I have swung the pendulum. I readily admit when I don’t know something and follow the statement up with an offer to learn or find out. A time when I showed this same vulnerability and it was a significant experience is related to my current role and the interview process. I was transitioning from a senior leadership role over a handful of departments in a mid-sized hospital to the chief executive of a small hospital- yikes! I did not want to over promise on my abilities, but I also didn’t want to lose the opportunity. I played up my strengths and quickly admitted my weaknesses and areas where I knew I would need to grow. I expressed an honest desire and willingness to close the skill and knowledge gaps.

I still don’t know everything but I DO KNOW that I never will…


I did this at the risk of losing the job. However, it worked in my favor and I got the job. I found out during my orientation that the leadership team places significant value on transparency. Good, bad, ugly- after all, it cannot get any worse than the truth. When I interview candidates to hire on my team, I am more focused on their personality, work style, motivations, and fit than their skills. In fact, aside from very rare situations I don’t bring them in to discuss their technical skills. I tell candidates I can teach them anything except how to be a good person and make good choices. Looking back, I believe my interviewers were seeking the same information about me. I have learned so much, and learn more every day. I still don’t know everything but I DO KNOW that I never will- and that is the key to balancing success with fulfillment.


Both are vulnerable-the egg to cracking and the hammer to a sticky mess…


Molly:  Well this question was timely in that I forgot it was a half day today for my youngest. He sat in the office for over an hour while the school tried to call me and my husband. We were both out of town and worse, I was on a flight to New York (5 hours). My husband called friends and family frantically from his meeting in Chicago. Being the champ that he is, my son quietly read his book until he was picked up. I took it as an opportunity to tell all of our kids that I messed up royally. I made no excuses of which I could share many (crazy schedules for a family of five, two different school calendars, blah blah blah). I want my boys to know that their parents are not perfect, we make mistakes, and take responsibility for them. I shared how I felt powerless to fix the situation at the time and was worried sick, but we can make a plan to ensure it doesn’t happen again.  I make a conscious effort to share with my boys how I make mistakes in both my personal and professional life hoping it will become ingrained that no one is perfect and trust is built when we own the mistakes and make it right.

Trish:  As leaders, we participate in all sorts of professional leadership coaching and training. I actively look for opportunities in addition to those activities provided by my employer. Several years ago, I completed a comprehensive professional leadership version of the Myers–Briggs Personality Type Indicator test and received a 30+ page results analysis document to pour over. The results of this particular test documented my strengths, challenges, and opportunities. It also had a section that documented how others would best work with me and I with them. One particular area in the analysis that was very interesting said that in communicating with me, others should, “Be bright, be brief, and be gone.” Wow. Did I have THAT low a tolerability for stupidity? Was I THAT impatient? Did I want people giving me information and getting out of my office the second they were done? I knew that being patient is a weakness for me (and it still is…but I am a work in progress). Many of the leaders in the organization quietly took their results and worked on themselves. I took my results and immediately did something quite drastic. I shared my results word-for-word with my management team. Talk about being vulnerable! The team and I laughed at some of the items as my team found some of them very true and also took note as a team member stated that “this one is sooooo me, too!” I realized that there was so much power and collegiality in being so raw as to show these results. Later, as conversations with my managers would occur, we would laugh together as they would give me a dig while saying, “I need to talk with you about an issue, but I promise to be bright, brief, and will be gone!”

by John R. Nocero, Jennifer RawleyMolly Downhour & Patricia Graham

Originally published on LinkedIn on 10/25/2018.

All About Ego- Truth or Lies?

John: I am working on breaking the habit of being self-serving. John 1.0 had a tendency to take credit for success and deny responsibility for failure. In other words, it worked because of me. If it didn’t, it was because of someone or something else. On some level, it makes sense; as it protects and builds your own ego. The problem is, if you deny responsibility for when something goes wrong, you can’t learn from your mistakes. John 2.0 is accountable to everyone and does not care who gets the credit, as long as he is a valuable contributor. This made me think about the last time I made a drastic mistake as John 1.0. Maybe you thought about it too. Did the mistake occur because you spoke too quickly, didn’t get all the facts before you made a decision, or alienated someone and ruined a relationship? Chances are it was either fully or partially your fault. After all, you were there. Pain and mistakes are your greatest teachers though; without them, how can you improve?

Question for my three friends: when was the last time, you protected your ego for fear of admitting a mistake and you missed an opportunity to learn?

Jen: I cannot think of a specific situation where this exactly applied, aside from silly situations with my kids. “No, Mommy never did anything like that…” Rather, I sometimes lean too far in the opposite direction and readily admit my lack of knowledge of something early on. Let’s just say that I may sometimes tip the balance of confidence vs. transparency. I have, however, had situations where I truly believed I understood an idea or a process and set out to undertake the affiliated task. Then downstream I realized I was mistaken and had to backpedal and work extra hard to get back on point.  A recent example was related to marketing and patient selection.  In my specialized healthcare field, there are specific criteria and stipulations from CMS that define which patients are candidates for our care. Over a year into my role, I found out that I was mistaken about one seemingly minor caveat related to length of stay calculation. I shared this incorrect ‘fact’ with many individuals during training and in business development meetings. I used it as a point of argument for why we could not accept certain patient populations.

It took an ‘ego hit’, but I made the right choice

and I learned what I needed to.

Thankfully, my misunderstanding did not have any impact on which patients we were able to care for since our internal policy aligned with what I had been saying, just not for the same reason.  I discovered my error when reading a peer-reviewed article on a different subject that happened to make mention of it. I had a jaw-dropping moment, and a knot in my throat as I dialed my boss to ask, “Have I been wrong all this time.” I risked my credibility when it was necessary for me to divulge and correct my mistake, but I did it quickly and with sincere apology. The bigger risk to my credibility, and my job, would have been to continue on sharing the misinformation, or even to dismiss it as if it never occurred. It took an ‘ego hit’, but I made the right choice and I learned what I needed to.

 Molly:  When I started my career in oncology clinical research, there were only five employees; two oncologists, two nurses, and one coordinator. It was all hands on deck and a great learning experience as I got to see (and do) most of the areas in clinical research. One of the areas I did not have exposure to was the clinical research contract, budget, billing, and negotiations. That was all taken care of by the university clinical research office in Tucson, about two hours south of Scottsdale, AZ. In hindsight, I wish I had taken the initiative to learn more about the process at that time. As I advanced in my career along the leadership path I quickly identified this as a knowledge gap for me. To shorten this gap, I earned my masters degree in healthcare administration, attended a clinical research finance boot camp, and hired a consultant to train our team. What was hard for me was going from being an all-around expert to having to lead a team that I had no experience in other than education. I was used to being the expert and having credibility for the changes I was recommending to the team. In this scenario, I wanted to improve our clinical trial contract language and budgets, but I was getting a lot of resistance from the team saying “this is how the industry has always been”. For financial sustainability we had to change. My solution to was hire people who I felt was a lot smarter and business savvier than me. I was very open about my lack of experience in this area when hiring. While I was uncomfortable not being the expert, it actually demonstrated leadership and character to surround myself with very talented individuals who raised the bar for everyone in the program and ultimately our patients.

Living in a loving and accepting family environment, I learned quickly in my youth that being transparent and admitting mistakes always helped me be a better person.

Trish:   I can’t think of the last time that I protected my ego for fear of admitting a mistake and missed an opportunity to learn. When John posed this question, I had to sit back and think about this question, had to even walk away for a few days, come back to the question and think some more. At the end of the day, I still can’t think of a time I have done this. I assume it was in my youth, and I probably did a fair share of lying to my parents after I screwed something up or hurt myself doing something dumb. Living in a loving and accepting family environment, I learned quickly in my youth that being transparent and admitting mistakes always helped me be a better person.

I’ve lived my personal and professional life quite comfortable with admitting mistakes and being forthcoming in my knowledge base. I also feel that as a leader, it’s important to create a culture in your organization or department that promotes the fact that mistakes are made, that they can be fixed, and we all move forth better and more educated. I’ve also worked hard to create and maintain this culture in my own household.

Now, I must admit that recently, I was using electric shrub clippers in the backyard and I was bit on the foot by several red ants (if you live in the South, you know that these ants are vicious and the bites sting and itch for days!) While being bit mercilessly, I cut wayyyyy through the thick outdoor electric cord! While yelling out to my partner, throwing the clippers away from me, and assessing the ant bites, I didn’t say that I ruined the power cord and almost shocked myself. I focused my verbal re-creation on the ant bites first and then said we needed to go to Home Depot and get a new cord. After a hearty laugh, my partner later said to me on the way to Home Depot, “Why don’t you wear socks and sneakers instead of flip flops when you are out in the mulch!?!”

by John R. NoceroJennifer Rawley, Molly Downhour & Patricia Graham

Originally posted on LinkedIn on 10/30/2018

Put Yourself Out There

Originally published on 10/12/18 on LinkedIN; By John R. Nocero, Jennifer Rawley and guest writer Ashley Heath

John: So Molly &Trish are still on the move and should be returning soon. Jen and I haven’t stopped though. We miss them but continue to put ourselves out there, especially with our connections here on LinkedIn. One of those we connected with is Ashley Heath, who is building her network here and contributing with us this week.

“When was the last time you put yourself out there?”

This got the three of us talking: When was the last time you put yourself out there? Like, I mean really, really put yourself out there? I attended a quality conference this week here in North Carolina. Among the myriad of great presentations, there was a chance to network. Usually, I reach out to others at these events, like some sort of glad-hander collecting business cards and introducing myself. This time, I did something different. I just hung back, chilled and let people come to me. It was very counter-intuitive, but it was the right move. It felt more like me. I felt if I could make one or two really good connections, then I had a productive networking experience. I put myself out there by stepping outside my comfort zone, staying quiet, but intentionally pushing my limits and that means I am growing closer to who I want to be. Letting others talk first is very scary. It is new, unchartered unfamiliar territory for me. But that is what forces me to grow, and when I did have interactions, , I was vulnerable, opened up and let others get to know me. I felt scared. And magnificent.

Ashley & Jen: When was the last time you put your full self out there? Any repercussions?

Ashley: I am not like John at all. I want others to talk first. I’m a person who stays fairly quiet in professional and networking settings. I don’t put myself out there, and even thinking about stepping outside of my comfort zone gives me anxiety. I have been on a job search for three years now, so I’ve had to put myself out there more in these past three years than ever. I’ve applied for roughly 70 jobs and have interviewed nine times, creating PowerPoints, scope of work plans, giving presentations, and I have yet to land a new role. Anyone who has gone through a similar experience knows how disheartening it is to work hard, be yourself, and truly put yourself out there to a world of strangers in hopes that they will accept you, just to be denied in the end. Still, I don’t give up, and I continue to put myself out there. I recently connected with John on LinkedIn and he encouraged me to try something new: put myself out there via LinkedIn to build my network. Since this was something I hadn’t tried before, I thought, “what the heck?” and went for it, full throttle. I began writing to people who are in roles I’m applying for or aspire to be in, I reached out to recruiters, I messaged alumni from my alma mater, and what did I get? Silence. I didn’t get a single reply. Even though it feels like I’m putting myself out there time after time and failing, I have learned a lot through this process. First and foremost, I’ve learned how to put myself out there and I have proven to myself that I can do it, even if it is frightening at first. I’ve discovered that there are several ways a person can put themselves out there, and I have accepted the fact that it isn’t always going to work out in the end. Most importantly, I’ve become more resilient, I’m no longer afraid to put myself out there, and I know that since I am learning from this experience, I haven’t failed at all.

Jen: I feel like I ‘throw myself out there’ in some way almost every day. I usually say I am ‘winging it’ and realize now that’s pretty much what I am doing. Thinking about a recent time I did this that was significant I keep coming back to writing. I have always wanted to write more, and it took meeting John for me to put myself out there more than ever before. I remember our first piece a few months ago, I sent him back what I thought was a draft and he published it right away! I cringed typo anyone?!?

Over time, it has gotten easier and easier and while typos still bother me, I have accepted them for sake of forward progress. This is out of my comfort zone, but it has allowed me to lower my stress and worry associated with writing. More recently, I took an even bigger leap and published my own piece. It was totally on a whim and emotionally driven from the experience. I hit ‘publish’ and snapped my computer shut before I had a chance to renege. It felt amazing! I am grateful for the experience and joy this has brought to my life. Everyone should find at least one thing today that they can do to move out of their comfort zone. Worst case, you will learn something new, even if it’s learning what won’t work for you. More times than not, I think you will find a greater freedom and renewed sense of purpose.

Dealing With Change

By John R. Nocero, Jennifer Rawley, Molly Downhour and Patricia Graham

John: I’m a fixed person. I like what I like when I like it. I get up at 4:59am. I am in my office by 6am. I leave by 6pm. At the gym, by 6:30, vigorous workout pre-planned from the night before. I am home by 7:15, for dinner, watch the Yankees, and then make my lunch for the next day. Saturday is similar to Sunday, with pre-planned routines. Needless to say, I love my rigidity. This goes for the majority of my life. I like new things, but when I am ready for them. My question to my other three friends is, how do you deal with change?

“How do you deal with change?”

Jen: Dealing with change is eventually inevitable – we can either fight or slowly lose, or we can accept it and adjust accordingly. As human beings, we are constantly changing, even the most stubborn of us are doing it at a molecular level. Some changes are optional, such as electing to take a new job. Some are not, like when we are forced out of a job. At the core, resistance to change is rooted in fear. Fear of the known, such as knowing chemo is required to treat a cancer; or fear of the unknown, such as not knowing where you will live after an eviction. These fears precipitate the ultimate sense of a loss of control, which can be the hardest part for many of us to overcome, myself included.  Imagine for a moment a ballerina performing turns- they can be any type of turn, but I like pirouettes and fouettes best, so I think of those. (If you can’t imagine or haven’t seen these, click here to see- starts at 00:40).

This ballerina is in a constant changing motion, but she controls it in one big way (yes, I realize there are dozens of other controls in play, just indulge me for a minute). Notice her eyes are focused on a single place and it’s not until most of her body is already turned that she whips her head around too and refocuses. She repeats this each time because she is trained to find the same constant point each turn. If she were to let her head spin around at the speed of her legs, she would quickly lose balance and fall out of the turn. Having danced as a girl, I recall that missing my focal point for even a single turn could render me unable to find it again, leaving me dizzy and in the floor. This example illustrates how I navigate change, by exerting control over other areas of my life to stay grounded. I remind myself of anything that I can control, even something small, like choosing what I eat. By doing this, I feel less “out-of-control” and manage thru the changes. If I don’t, I eventually fall flat on my face. Of course, I simply jump up and pretend like it was supposed to happen, relocate my focal point and keep on spinning.

“…there are two types of change; change you choose and change that is forced upon you.”

Molly: I agree that there are two types of change; change you choose and change that is forced upon you. I like change and I recognize I can easily get frustrated with the status quo when I feel strongly there is an opportunity for improvement. I enjoy solving problems rather than applying temporary fixes and I hate waste (especially my time).

When change is forced upon you, I (like a lot of people) try to understand the rationale behind the change. Unfortunately, not all changes can be understood, such as a natural disaster or a terrifying diagnosis. As an oncology nurse, I have had the privilege of seeing so many wonderful people face the life changing diagnosis of cancer with courage and grace. Courage, grace, and determination come after denial, anger, and questions of why me. Supporting my cancer patients through this process gave me great insight on how I want to face change that is thrust upon me. I let myself experience the emotions as I feel that is a necessary step in determining my path with the change. Then I can decide if I want to fight it, embrace it, or maybe warm up to it.

Trish: Great question, John. This is a very interesting topic. As Jen mentioned, we are constantly changing and the world around us is in constant change. This change occurs with or without our buy-in, and ultimately, it is how we deal with the change that determines whether we are dealing with loss or control.  I like to think of this quote, “Change is a process, not an event.” Somehow, this thought process allows for the element of time. Time to get from Point A to Point B. Some people adjust to change with speed and grace. The speedy graceful people are at Point B smiling and cheering. Other individuals are resistant to change and fight very hard to maintain the current status quo. You can find these individuals still processing the fact that there is a Point B that exists, and heck no, they don’t want to get there at all…let alone get there with speed AND grace! I think I am somewhere in the middle, but more toward the person on the fast road to Point B. Why am I a “somewhat speedy and graceful” change acceptor? I Maybe I don’t like to feel a sense of fear and loss and focusing on the excitement of something new helps me manage the change. The concept of viewing change to be a process and not an event allows individuals time for consideration. This consideration may make a speedy graceful person slow down and discover challenges that need addressing before getting to Point B that they otherwise may have missed. Viewing change to be a process and not an event may allow a resister time to consider opportunities rather than be steadfast in opposition. The next time I am faced with change and feel like I am on the too speedy graceful side of the bell curve or I am too far to the resistant side, I hope to stop, take a breath, recognize that the change is a process and not an event and decide the best way to get from Point A to Point B.