Adventures in school nursing

Betty Irelan, RN - looking back on 28 years

(Kelly Cook for On Call) Betty Irelan, RN, consults with a student on one of her last days of work.

A few days ago, June 25 to be exact, Betty Irelan, RN, started her permanent summer vacation. After 28 years as school nurse and nursing coordinator for the Groton-Dunstable Regional School District in Massachusetts, Irelan retired from a job she originally planned to hold for only a short while.

Irelan began her nursing career as a clinical nurse. But between 1968 and 1980, she took a hiatus from nursing to start a family with her husband Al. When their two children, Lisa and Peter, were old enough and she was ready to go back to work, Al showed her an ad in the paper. Their local school district was looking for a school nurse, and Irelan liked the idea of working close to her children and sharing their schedule. So she applied.

"It's funny how I ended up with my career kind of by default," Irelan says. "I thought I'd do the job for about three years and then go back to a clinical setting." But she found reason to stay. "The pay is lousy, but the hours are good. And every day I went to work and had fun. I have never once gotten up in the morning and said, 'I don't want to go to work today.'"

Skill, concern, and social diplomacy - the arsenal of a school nursing
The major difference between working in a clinical setting and being a school nurse is that a school nurse is often the only person in the building with a medical background. That means the job can be a little isolating at times. "Normally, you don't have anyone to discuss a situation with," Irelan says. "So you choose to err on the side of caution. As you assess different situations, you build on your experience and gain more confidence in your judgment."

"Betty doesn't need much help," says Richard Staub, MD, a retired, local pediatrician who gave sports physicals and with whom Irelan has had a professional relationship for 26 years. "She stands out not only for her competency but also for her devotion to her work and the kids. This has been much more than a job to her." Staub says students like and trust her, "because it is clear to them that she is deeply concerned for their welfare." He surmises that Irelan will need to be replaced by two people, given her level of medical skill and social diplomacy.

Irelan's diplomatic skills were a necessary part of her profession, and they became especially honed because she worked in the community where she lived. It's common for her to be recognized in a store or on the street. Parents occasionally stopped her in public to ask questions about their children or their children's peers. This happened more so when her own children were enrolled as students in the district.

"Of course, I never shared anything because of confidentiality," Irelan says. "It didn't stop them from trying though."

A sense of humor - how to survive as a school nurse
Younger children unabashedly recognize Irelan for the local celebrity she is. Once when Irelan was in the market, an elementary student saw her and excitedly yelled to his mother, "Look, mom! It's the old school nurse!" - innocently meaning, of course, the nurse who used to visit him in preschool. Irelan laughs at the unintended irony of his comment. And this has been the key to her longevity in her position - finding the humor and delight in almost any situation.

Irelan believes every nurse needs a sense of humor because nurses deal with life and death situations all the time. Situations are not always grim, of course, and working in a school setting has given her plenty of unique things to laugh about.

In her early years, Irelan made home visits to families of children who were doing poorly in school. She made these visits to rule out physical disease as the cause. "One family was living in a trailer on the outskirts of Groton," Irelan says. "They welcomed me in, we had a nice visit, and they felt reassured to know I could help them. As soon as I left, they turned off their light. It was pitch black. I couldn't see and walked right off their deck, dropping six feet. Luckily I fell on the grass. When they heard my yell and a thump, they turned on the light, and I was able to make a more dignified exit to my car."

Becoming immersed in the school community
Irelan's patients, especially the young ones, have taught her the art of being clear. "I used to wear regular clothes to work, but this was confusing to the little kids and even their parents, so I started wearing scrubs," says Irelan.

When a simple request caused a slight panic, Irelan learned to give a literal explanation for everything. "One little guy managed to stick his finger through a hole in one of those plastic rulers," she says. "His fingertip was starting to blow up, so I asked the custodian to bring me a small saw. I saw the boy's eyes widen, and I quickly realized that he thought I was planning to cut off his fingertip. When I explained that the saw was for the ruler, he calmed down."

Then there was the first time she chaperoned an international trip. The high school tour group was set to leave Stonehenge when they noticed someone was missing. Irelan suspected that, because the missing student had a seizure disorder, he might have become disoriented. "I went back in, and there he was on the opposite side of the circle from me," says Irelan. "I went toward him one way, and he changed direction. This went on for about 20 minutes, until I finally fetched him."

Irelan chaperoned her last international trips - to China and Spain - this past spring. Chaperoning is not a requirement of her job. Rather, it is a testament to her immersion in the school community and her love of the students she serves.

Along with nursing, Irelan has been a classroom teacher, writing the original curriculum for the high school Health course and was the first person to teach the course. "Because I am a nurse, the students felt comfortable talking with me about everything," says Irelan. "For the sex education part of the course, I carried my samples in a Talbot's bag, and my colleagues laughed when they saw me with it because they knew what was inside."

After one class, Irelan forgot her Talbot's bag on the floor of the classroom, and that night, one of the custodians, who didn't know its contents (or maybe because he knew the contents), threw it out. This became a standing joke at the school.

Creating a healthy atmosphere
Irelan started the school's Peer Leader program, which has been running since the mid-1980s. Initially funded by a grant Irelan received from the Federal Department of Transportation and run as an after school program, a key component has always been high school students visiting younger students to talk to them and teach them about how to avoid risky health behaviors.

One of the first student members of the group was Jennifer Brennan (now Jennifer Gervais, RN). Gervais was inspired by her club adviser to become a nurse herself. "Betty's personality, warmth and caring made me want to go into nursing," says Gervais. "We've exchanged Christmas cards since I went off to college, and whenever I ran into her in town, she'd joke about how one day I'd take her job."

Gervais has followed a career path similar to Irelan's. She started her career in nursing at New England Medical Center in Boston and then served as a community nurse in Lowell. Now in Groton with young children, Gervais is a substitute nurse and has worked for Irelan as her schedule permits. "I have the highest respect for Betty," says Gervais. "She's wonderful."

As much as Irelan would like her prophetic jest to come true, it looks as if the timing is slightly off. Gervais says she isn't quite ready to balance raising her children with full-time work.

In the same way Irelan has influenced her students, her students have influenced her. The student who had the biggest impact on her was an eighth grade boy whose cancer took one of his legs. He really wanted to be at school, and continued to come no matter how sick he was. His courage and sense of humor inspired her.

"One day he came into my office, holding his prosthetic foot in his hand, and announced, 'My foot fell off, Mrs. Irelan. Do you have a screwdriver?' From that day on, a tool kit became part of my nursing supplies," she says.

Irelan is amazed at the strength she sees, especially in young children. "They accommodate to illness really well," she says. "One minute they are really sick, and the next they are running around."

Working with high school students can be a little trickier because their health problems often reflect a poor choice they've made, whether it's substance abuse, pregnancy, an eating disorder, or mismanagement or denial of a diagnosed condition.

"Every encounter with a student, no matter how small the problem, is a teaching moment," says Irelan, who has always considered herself a teacher first. "I always ask them what changes they can make to improve their health. With some, though, emotional problems are tied to physical ones."

For these students, graduating from high school becomes more than a personal effort. They rely on key members of the school community to help them get through. "I tend to have more consistent contact with the kids who, maybe, are not going to graduate," says Irelan. "My thrill is to see them graduate and know I played a role in getting them there."

Irelan's role, according to her peers and charges at the school, has been invaluable for the last 28 years. But her success lies in the way she has underplayed that role. "I mean when I think about how many heads I've checked for lice, I have to laugh," says Irelan. "I remember one time I was checking an elementary music class, and a five-year-old looked up at me and asked, 'Do you know what the hell you're doing?' I kindly explained to him that I did."