Desirable Difficulties

What doesn’t kill you makes you stronger

I once had a conversation with daughter of a patient of mine. I had just complimented her on how well she was handling her father’s (terminal) illness. Since we had met I had noticed how matter-of-fact she was about her father and his needs. The daughter was a model client and very easy to please. She understood home care and Hospice and all of the challenges that go with having multiple caregivers in her home.

Then the daughter shared with me where her strength came from.

She told me that she had a “bad time” with her son last year. She said that after what she lived through last year this was “nothing”.

At first I couldn’t believe what she was saying. What could be worse than watching your parent slowly die?

And then I understood.

As a parent, there is absolutely nothing more painful than watching your child suffer. I have no idea what happened to her son and I assume he is ok now.

What doesn’t kill you makes you stronger.

In one of my favorite books, “David and Goliath” by Malcom Gladwell, a condition called desirable difficulties is explored. Desirable difficulties is a theory  that explains how the underdog can overcome and even excel. Gladwell cites a study from The City University of London that states in the past 20-30 years, the most famous inventors and innovators have at one point, been diagnosed with a learning disability.

Gladwell further explains that there are two possible reasons for this fact.

  1. They excelled in spite of their disability OR
  2. They succeeded because of their disability

A couple of years ago I was on my way to a holiday dinner for the company I worked for. I was late because I was on the phone dealing with a serious issue at one of my kids’ schools. My son was in trouble for something (I really don’t remember what the issue was) and he was suspended as a result. I apologized when I got inside the restaurant and explained briefly what was going on. In response my boss said he had been kicked out of several high schools.  Clearly my boss had succeeded in his career, either in spite of, or because of his challenges. He was a very successful business man and it really put things in perspective for me.

When I started nursing school I was in the middle of getting divorced. It was a process that went on for many years. Understandably it caused me a lot stress. Being a single mother while I was struggling to do well in nursing school-at the same time I was going through a divorce-made me feel like I was fighting in a war every day. I had no local support network and very limited financial resources.

I was not a star student. My grades were always just “good enough”. I studied like crazy but could never seem to get really comfortable with the material. I never failed a class, but I never passed by much.

In additional to learning in class, we also had clinicals and return “demos”. This meant that I had to demonstrate a skill that we had learned in front of my professor and receive a grade. As a group, my class had to decide together which student would be tested first. I always volunteered to go first.

My first semester nursing professor, Professor Soto, didn’t like me at all and did not mind making that obvious. I was sometimes 5 or 10 minutes late for our 8am class. I think she felt disrespected but refused to listen to me when I tried to explain that I live over an hour away and my son’s nursery school won’t take early drop offs earlier than 6:30am. Please note that in order to get my son to school by 6:30 am it required waking him up disgustingly early while getting myself and my slightly older daughter ready for school and leaving the house by 6:15.

She didn’t care.

But neither did I.

I wasn’t scared of the Professor. And I ALWAYS went first during our demonstrations. Sometimes I did well and sometimes I tried to spike an IV bag with the wrong end of the tubing. But I was not afraid of Professor Soto.

Did my client’s daughters’ experience with her son make her stronger? Do people with some learning disabilities have an advantage in business? Did my divorce help me through nursing school?


I would never wish difficulties on someone, even if they have desirable results. But I have to admit-I am very proud of the person I have become-as a direct result of my challenges.

Lessons I’ve Learned:

  1. You never know what people are going through.
  2. Crappy experiences can give you the tools to deal with future crappy experiences. 
  3. You’re stronger than you think you are. 



How to stop being a follower

Before I became a nurse I held a variety of jobs that were all “supporting roles”. I mostly worked in offices as a secretary or assistant. I was always happy with my jobs and I was lucky enough to never have a bad or mean boss. Looking back I really feel that I always did my best (except that first real job where they fired me for making too many personal calls-horrible memory).

When I became a nurse I got my first job in a large home care agency. I was completely on my own. When I did ask for help or guidance I seldom got it. Often I would ask multiple people for help and get conflicting responses. My lack of guidance at this job was concerning to me but I was a new nurse and I didn’t want to stir the pot. I stuck it out for several years and managed to (mostly) stay out of trouble. I quickly learned to do what was easiest for me. I asked for a raise and got it. I worked quite a bit of overtime and was impressed with all of the money I was making. If nothing else, I was very happy with the money. I left this job because I moved out of state but I also recognized that I was in a potentially dangerous position.

I decided to look for a big name home care agency. I applied to two and got one offer and took it. I had to take a pretty big pay cut but I figured it was worth it.

It was. Sort of.

I had incredible mentors and tons of support from amazing nurses and other professionals. All of the higher ups expected me to preform at my very very best and I liked that. I was sure that my hard work would be rewarded, and it was. I was promoted several times and given more  responsibility. I was never given a raise and actually made less money over time because I couldn’t work overtime in a management position. I requested to return to my field position and permission was granted. I became more and more resentful as I realized that although my hard work was truly valued I was not going to be financially reimbursed. I left the job because I was totally overwhelmed with the amount of work and was not being adequately compensated.

My new job was significantly less work with essentially the same amount of money. Here I learned the importance and advantages of real friendships in the office. I loved the people I was caring for and the people I was working with. I gained insights about business and finances. I took on new responsibilities and always tried to go “above and beyond”. I googled “When to ask your boss for a raise” and “How to ask your boss for a raise”. I read article after article. I was NOT going to make the same mistake I did at my last job where I never even asked for a raise. It would not have taken much for me to feel appropriately compensated. I agonized over the conversation I would have with my boss and I imagined all of the potential responses and all of my potential come backs. When I finally worked up the nerve to ask my boss, I got a vague response and a promise to re-visit in several months. That next conversation never took place. I left that job because a friend dropped my name to a recruiter who just happened to have an opening he was trying to fill.

I let the recruiter guide me in the interview and negotiation process. I felt I had learned from my past mistakes. I presented myself confidently and I asked for a salary that I truly felt reflected my value as an employee. Then I googled “How to tell your boss your quitting”. I read article after article. I spoke to my boss with a well measured, pre-planned speech.

Me: Can I speak to you for a couple of minutes? (I close the door to her office)

Boss: Wow, this must be serious.

Me: Yea.

Me: I was offered another job and I have decided to take it….

Boss: What? Why?

Me: They made me an offer I couldn’t refuse.

Boss: When is your last day?

Me: 4 1/2 weeks from today.

She said she understood and I had promised myself I would not say more. My research explained that I didn’t need to explain or justify. So I didn’t. It was a completely different feeling than I had experienced professionally in the past. When I quit my first job I practically whispered the information to my superior. When I left my second job I literally burst into tears and told my boss “don’t be mad at me”. The conversation with my most recent boss was not just the right decision for me but it also marked a change in the way I saw myself as a professional

hiresSo, here I am. Three months in to my new job. It is completely different than what I expected. I am challenged every day to be more and do better. I wear pantyhose, heels and makeup. I learn something new every day and I push myself to make the best decisions for the company and the best decisions for the employees that I supervise. I use the lessons I have learned from the followers and the leaders throughout my career.

But most of all, I spend time wondering how I could have done things differently and if that could have changed my career path. I look back on the missed opportunities and wonder where I could have ended up. I wish I had had some guidance or a mentor to help me navigate through the world of a new nurse and a new professional.

I have committed myself to be the kind of leader I wish I had when I became a nurse. I give advice and gentle criticism, I offer encouragement and counsel, I suggest alternatives and solutions. I refer clients to other companies where I have relationships-because that is what I would hope others would do for me. I have had opportunities to help people with professional connections for new jobs.

I am not perfect and I have so much to learn. But I am grateful every day that I am here.

Lessons I’ve Learned:

  1. Trust your instincts.
  2. Take risks.
  3. Don’t be afraid to ask for help and offer help. 

How’s the Weather?

I work as a field nurse supervisor for a home care agency. This means I do a lot of supervising. I don’t provide a lot of “hands on care” to my patients. Don’t get me wrong, I love, LOVE, what I do. But I get really excited when I have a chance to get down and dirty with some bodily fluids.

I have a very special patient who receives visits from a nurse from my agency for a urinary catheterization. This means that there is a small tube inserted into her urethra in order to drain urine from her bladder. If you are interested in a more in depth explanation, feel free to click here or for a ridiculous video demo, click here.

I went to see my patient every month for several years. My function was to “supervise” her care. We would talk about her children and her grandchildren, about her medications and her doctors’ appointment, and about anything else that she wanted to talk about. Sometimes we spoke about her childhood in Europe, how her grandmother was a caterer or how she came to America. I always enjoyed our visits.

One day I went to see her for a regularly scheduled visit and it became apparent that she needed a urinary catheterization. There’s a long back story that I won’t get into, but the bottom line was that my patient was not happy with the new nurse’s technique  so she had cancelled her last visit. Of course, this was not a great idea because the procedure needed to be done, I knew that the best thing for the patient was for me to take care of her at that moment.

Right away I realized a couple of issues:

  1. I hadn’t done a urinary catheterization in quite a while
  2. Well, see #1

I asked her where her supplies where and moved my ID badge into my shirt (yes, that’s a thing we do to prevent gross stuff from getting on our IDs). Then I put a pony tail in my hair, then it broke. I attempted to tie my hair in a knot to keep it out of my face, I was partially successful. I followed procedure beautifully and set up my supplies and began the procedure. It quickly became apparent why the new nurse was having trouble with the procedure. If you have every done this procedure on a woman, you know, some are easy and some are…not. This was one not easy. The patient was patient (lol) with me and we managed just fine. Of course by this time I was sweating and my hair was partially obstructing my view but I was thrilled because the urine was successfully draining.

Quick urine lesson. Healthy pee is light yellow. Dark pee usually indicated dehydration. “Cloudy” pee or sediment (shmutz) often means that there is an infection present.

I was trying to make conversation and appear noncholant while I waiting for the urine to drain.

Me: Are you ok? Are you having any pain?

Patient: Is it cloudy?

Me: No, its nice out today.





6 Reasons Why Home Care?

Home care, visiting nursing, community nurse…we are called many things. But that doesn’t change what we do. Nurses who make home visits, regardless of what we call ourselves, are all the same and have the best nursing job on earth.

I became a nurse for many reasons (see my previous post for details). I knew I needed a job right away so I interviewed A LOT. It quickly became apparent that I had some problems. First of all, I couldn’t work nights, this was non-negotiable. I was a single mother, and I had no one to watch my kids. This made me very unattractive to hospitals. I also didn’t want to work on Shabbos (Saturday), also a problem. I needed reasonable hours and/or something close to home (see single mother excuse). I wasn’t discouraged while I was going to all of my interviews and not getting any offers, I knew something was going to come up.

It did.

I got an offer from a staffing company to work per diem at their flu shot clinics. Back in the old days before CVS and Walgreens started giving flu shots, they used to hire companies to staff flu shot clinics at their stores. I went to pharmacies and large businesses and gave many, many flu shots. One woman complained that I didn’t really give her a shot (I did). She said it didn’t hurt at all and therefore I must be lying about giving her the shot. I told her it didn’t hurt because I’m REALLY good at giving flu shots. She didn’t buy it. After that moment I changed my pre-shot speech. Instead of giving the usual list of possible complications and contraindications I added, “the shot may not hurt, but if you want it to, I can arrange that.”

Eventually I was offered a spot in a training program at a home care agency. It was a dream come true (thanks to Sammy and Aviva). The program offered in class training for several months and then orientation in the field and a gradually increasing workload to productivity. It was a challenging time and I made plenty of mistakes but I made it through. I learned quickly that I had the perfect job. I stayed at that job for three years and my next home care position for three years and am at my current position for one year. I NEVER want to leave.

When you see a hospital nurse she is really busy, focused and usually very serious. Home care nurses are always smiling, why is that?

My patients often ask me about my family and how many children I have. Then they all ask exactly the same question, “When do you relax?” “I’m relaxing right now”, I tell them. That is not a joke.

  1. Independence. 

No one was looking over my shoulder. That may sound like a bad thing when you’re a new nurse, but it wasn’t. I may not have done things perfectly right on the first try, but I figured things out. Coming to the solution on my own was very satisfying and exciting as a new nurse. I had a supervisor and case managers in the office who could sometimes answer my questions when I could get them on the phone, but I learned not to bother.

2. Flexibility

I don’t just see patients in their homes. I have done new employee orientation, HHA classes, chart audits, quality control, community lectures, staff education and competencies. Sometimes its nice to spend some times in the office.

I decide when to see each patient. If the patient isn’t available when I want to see them (most were, they were usually homebound) we would chose another option that worked for both of us on a different day/time. This meant that I could go home and eat lunch…or go out for lunch (which nurses get to actually eat?). It also meant that I could schedule doctor appointments for myself or my kids and plan my patients around that appointment…or my kids school play, or a teacher conference, or a trip to the mechanic to get an oil change, or the post office. How do working mothers get things done?

3. The patients

I can sit with my patient for an hour talking about; the photographs on their walls, the numbers on their arm, what they’re cooking on the stove, the work they did “before”, the origin of their last name, their garden, their dog, their paintings, their piano…Of course I discuss their medical history but only after we have made friends. Why would I do it any other way? If I do a good job and I ask the right questions, most of my home and health assessment has been completed before I ask any of the questions on my nursing assessment. My patients are happy to share personal details with me because they trust me. When I teach new nurses I remind them that we are a guest in the patient’s home. We must ask permission before we sit down or place our bag on a chair.

4. The stories

My patients share the stories of their lives with me. Stories of immigration, illness, happiness and sadness. They trust me with the stories that make them who they are. I have met some truly amazing people who have experienced truly wondrous things. I am always humbled by the gifts they give me in the form of memories.

5. The money

The money is comparable to hospital nursing and the opportunity for overtime is usually available depending on the type of agency you work for. Even if your agency does not have overtime availability you can work for other home care agencies per diem while you are working full time for another. I have done this and it has created quite a financial opportunity for me.

6. The nursing

I have treated a wide variety of health issues. No matter what you may hear, home care IS real nursing. Wounds, staples, trachs, PEGs, foleys, sutures, vents, amputations and many more.

I may see a patient two or three times, or I may see them daily for years. Either way I am invited into their life. In this environment I have the ability to help my patients make real changes and I have the honor of watching it happen.