Celebrating 50 Years: A Nurse’s Role

As Gardner Health Services celebrates its 50th anniversary, it’s important to remember those employees who were instrumental in Gardner’s longevity. The organization grew like a tree from concrete to become the largest healthcare safety net in the County of Santa Clara. Norma Avalos is one of those employees who has kept Gardner rooted over the years. She first joined Gardner 32 years ago and ever since she has embodied the grit and determination that define the organization’s success.
Norma began her nursing career in the 1970s in Washington State. During this time, she began working at a migrant health clinic about 70 miles north of Seattle. It was here that she got her first taste of working in a community-based health setting and it left a lasting impression on her. Years later, while working at the VA hospital in Palo Alto, Norma heard about a local clinic that was hiring for a part-time position. The desire to work in a community clinic was still lingering and Norma was very interested. She applied and got the job with Gardner Community Health Center, as Gardner was known back then. She began working mainly on Saturdays with a doctor, fulfilling the role as a nurse. Soon after beginning, Norma met the nurse practitioner at Gardner who recommended she apply for another part-time position at the Family Health Foundation of Alviso. The Foundation was looking for a bilingual nurse to work with their Spanish-speaking patients. Norma applied for the position with the Foundation and to her surprise was offered a full-time job instead, which she accepted.
Norma’s time at the Foundation began as a trial by fire. She worked as the clinic manager, although she had no experience in that role, and was quickly trained to fill the position. From clinic manager she was elevated to triage nurse and provided triage services for three different clinics under the Foundation. “That was really challenging because I was doing OB/GYN, pediatrics, and general medicine and I was getting a call every three minutes. It was pretty much a burn out job because you’re talking to people constantly and they’re needing something from you.” However, returning to community health turned out to be everything that Norma had hoped for. “In the private sector I felt more like a glorified waitress… (Gardner’s) patient population comes in because they really need to be seen. And that makes a big difference as far as the nursing skills are concerned and your empathy and your commitment to the patient,” she says, “But as much as it burned you out, I really enjoyed working with that population.”
Norma attributes her ability to empathize to her humble beginnings as a child. She recalls having to ride the bus with her mother and siblings to get to medical appointments. Norma and her family would often have to wait in long lines to be seen at the community clinic. Now as a healthcare provider, she understands the frustration that patients might be carrying before they’re attended to, “They’re angry, they’re upset, they don’t know you from anybody else. But it’s all your fault that morning, but you know to calm them down and to let them know you really want to help them,” she says.
Intertwining periods of challenge and growth have come to define Norma’s experience at Gardner Health Services. During difficult times, she didn’t have a chance to catch her breath, but always kept her momentum moving forward. “As a professional I have been exposed to so many situations that even if I had paid for the experience, it wouldn’t have been the same. I couldn’t have learned any of this in school. Being there and practicing, I learned so much.” Norma remembers one challenge in particular as being both an eye opener to the realities of healthcare but also a great success.
During a financial drought, Gardner was forced to downsize its operations, including the elimination of delivery services for expectant mothers. “We had numerous prenatal patients, and nobody to deliver them, and I tell you I remember those days like they were yesterday because it was a challenge!,” says Norma. Gardner’s CEO, Reymundo Espinoza, and Norma began meeting with potential partners to resolve the situation. For the first time, Norma was able to witness the organization’s leader in action and the weight of responsibility that fell on Mr. Espinoza. Together they went to different organizations asking for assistance in providing delivery services. Eventually, they found a doctor with a private practice who agreed to provide prenatal services for Gardner’s patients and to deliver the babies. “There was anxiety and stress and excitement at the same time because you work yourself up to the challenge of something new. Can this be done? How can it be done? And from that experience I learned a lot of how to negotiate because I watched our CEO negotiate so we got (delivery services) and to me that was a great accomplishment.”
At one point, Norma was serving as the director of nursing and the director of operations at the same time. She was doing her boss’s job and her own job as well. She had always wanted to go back to school to finish her bachelor’s degree but never had the time, she was too involved with Gardner. All of that change two years ago when Norma enrolled in classes to finish her degree. She was so glad she had returned to nursing school because it highlighted the stark difference between her education in the 1970s and how the profession had evolved since. “One of the classes I took was holistic nursing and one of the things I learned was that back in the day when I initially went to my first nursing program, I was taught that you kept your feelings to yourself. When you gave notice to your patient that they had some kind of dreadful news, you were to keep your emotions to yourself.” “But today it’s a whole different ball game for nurses, they encourage you to not only share your experience and your feelings but even to attend your patient’s or your client’s funeral if the door for that opens.” At the beginning of this year, Norma began putting into practice new techniques she had learned to treat her patients, including offering to pray with them. She was referred a few patients that were depressed and one of these patients in particular was very broken down. So, the first thing that Norma asked the patient was if they believed in god and if she could pray with them. Right then and there they began to pray and she began to calm down. They made an agreement to continue meeting twice a week until the patient could join a mental health program.
The connection to community and developing relationships also carries into Norma’s personal life outside of work. On the weekends she supports her son, a pastor. Unlike a typical church, her son’s ministry takes him out into the community, including three Native American reservations and a national motorcycle organization. Norma is also very active in her son’s band, which meets every Sunday. Norma’s son released a music CD which made the rounds at Gardner, eventually making its way to Mr. Espinoza who keeps a copy in his car. The lyrics of one particular song have made Norma and Mr. Espinoza reflect on their work here at Gardner,
“Everyone wants to go to heaven, but nobody wants to die. Everyone wants to laugh, but nobody wants to cry.”
After 32 years with the organization, in various roles and managerial positions, Norma has a unique perspective on the success of Gardner. From her perspective, the greatest asset to Gardner’s progress has been our employees, “If we continue to have the heart of Gardner, the human side to it, not only the professional, but the human side that reaches out to our patients… I’m hopeful that we will not only continue to have good quality care but also be financially stable to meet our goals,” she says. In the meantime, keep an eye out for Norma’s future book, which will include several stories about Gardner, including this gem:
One of Gardner’s clinics, CompreCare, was previously located about a mile from its current site. The clinic sat in between two bars, which provided unique challenges for the staff. The bars were very active, providing live music and dancing.

“The bands would practice during the day and I would have to go to either one and say ‘Keep it down because the doctors can’t hear themselves talking to the patients.’ And actually with the drums and saxophones you could feel our walls vibrating. This one evening I got a call that a car had crashed into the clinic. I thought, ok, I didn’t live too far from there, so I got in my car and drove there. To my surprise, a whole care went way inside the clinic! It was all window, it was like a storefront window, huge, and the car broke the whole window and was more than halfway inside our lobby.”

Norma stayed to oversee the cleanup. Once the window had been properly boarded up she called for backup from the clinic’s security service so that she could finally go home and rest. “At the time it wasn’t funny, but now I laugh about it.”
Content curated by Antonio Nunez, Jr.

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