Stressed from pediatric oncology needs career advice

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Hello Nurse Beth ,

I'm here again. I have listened to your advice before and now I would like to get advice again.

I am a pediatric oncology and bone marrow transplant nurse in Turkey, working at a well-known institution affiliated with an American hospital. I have over 3 years of nursing experience (ICU, mixed surgical ward, and now oncology).

Although I love my patients, the workload in my unit is extremely heavy. I often feel burned out—I struggle to sleep after shifts, have stress-related symptoms, and sometimes work entire shifts without eating. This makes me wonder if transferring to the ER might be a better option, especially since in my hospital the ER workload is lighter.

At the same time, I am studying English and preparing for the NCLEX. My long-term goal is to work in the U.S., hopefully as a CRNA in the future. My concern is: would moving from pediatric oncology to the ER negatively affect my career path if I want to pursue ICU and advanced practice later?

Nurse Beth, what would you recommend? Should I prioritize reducing my burnout now by moving to the ER, or should I stay in my current specialty for the sake of my future career in the U.S.?

Thank you very much for your guidance.

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Specializes in Tele, ICU, Staff Development.

 

Hello again, and thank you for reaching out. I understand the intense workload and intensity of practice in pediatric oncology and bone marrow transplant nursing.

I'm glad you're prioritizing your health as you plan your NCLEX, English study, and future move to the US. Here's a focused take tailored to your context (Turkey, an American-affiliated hospital, ICU/ER pathways, and CRNA goals):

Burnout first: health as the foundation

Your sleep, nutrition, and stress symptoms are signals that need attention now.

Practical steps:

  • Schedule a medical/psychological check-in if sleep or appetite issues persist for more than a few weeks.
  • Implement a concrete burnout plan: establish a consistent sleep schedule, plan meals and meal prep, take micro-breaks during shifts, maintain hydration, and set boundaries to protect your rest.

ER now vs ICU later: how it affects your CRNA path

  • ER experience can develop acute-care decision-making skills and tolerance for high-stakes situations, which CRNA programs highly value.
  • However, most CRNA pathways emphasize solid critical care experience (ICU). If you move to ER, plan a clear bridge to ICU exposure in the near term (e.g., post-NCLEX ICU shift, a critical care internship, or a targeted critical care role in a U.S.-affiliated setting after licensure).
  • Realistic framing: ER can be a stepping-stone, not a detour. The key is to document how you sustain or build ICU-relevant competencies alongside ER duties.
  • You can pivot back to a more ICU-focused role when you're ready, or pursue specialized critical care positions. In the US, the ER experience typically continues to provide valuable skills relevant to advanced practice.

Concrete trajectory considerations

  • Licensure and timing: In Turkey, ensure you understand how ER vs. ICU rotations map onto US licensure and visa processes, and how your American-affiliated institution can support your transition.
  • Bridge to US pathways: Map a plan that includes a defined ICU exposure (perhaps post-licensure) within a reasonable timeframe, and document critical care responsibilities that programs recognize (airway and ventilation management, organ support, hemodynamic monitoring, etc.)
  • Start a portfolio for a CRNA application to capture and include critical care competencies and experiences.
  • English and NCLEX alignment: Coordinate your study plans with clinical experiences so you can translate your practice into U.S.-practice narratives.

Final takeaway

Your health comes first. If moving to ER provides meaningful burnout relief, it can be a smart interim step—as long as you commit to obtaining robust ICU exposure afterward and align it with your NCLEX and visa timelines.

Your goal-oriented mindset is a strong asset. With a concrete, staged plan, you can preserve momentum toward ICU experience and CRNA entry without compromising well-being.

At the same time, don't overthink things. Transitioning to the ER won't prevent you from becoming a CRNA; there are many paths to acceptance—this move isn't a take-or-break situation. Yes, ICU experience is essential, but again, you can gain a year or two of it in the US after obtaining your license.

Best wishes,

Nurse Beth

 

 

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