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What Is Step-Down Nursing? A Definitive Guide

September 30, 2021

When patients are in the process of transitioning out of intensive care, a step-down nurse helps take care of them. Also called progressive care nurses, step-down nurses provide specialized attention and care to individuals who don't quite qualify for the ICU or the general medicine (also known as med-surg) floors of a hospital. For those interested in step-down nursing, learning about the what the job entails can help them decide if it's the right career for them. In this article, learn about what step-down nursing is, the duties, benefits and challenges of a step-down nurse as well as the education, skills and salary typical of the job.

What is step-down nursing?

Step-down nursing is a career where trained medical professionals work with patients who are transitioning out of the intensive care unit, but typically require more care and attention than patients on the general floors of a hospital. In other cases, ill patients on the med-surg floors may be in need of more medical attention and are transferred to step-down care.

Step-down nurses treat people experiencing many kinds of ailments, including cardio, neuro, surgical and ER patients, as well as those with chronic illnesses. Because of this, they must be well-versed in medical knowledge and personable patient care.

Related: How To Become a Nurse

Duties of a step-down nurse

Step-down nurses need to be able to give meticulous care and assist with life-saving procedures, especially since they work with patients who need close monitoring. As transitional caretakers, step-down nurses have the following duties:

  • Checking patient health status daily and making note of any changes or concerns
  • Caring for multiple patients throughout the same shift, often varying in age and condition
  • Monitoring patients with life-saving medical equipment, including IVs, catheters, feeding tubes and ventilators
  • Responding to code blue alerts and other urgent situations
  • Providing a comfortable and secure environment for the patient while acting as an advocate on behalf of them and their loved ones

Benefits of being a step-down nurse

Step-down nursing is a demanding but often gratifying field for medical professionals seeking to make a substantial difference in the lives of patients. Here are some benefits to becoming a step-down nurse:

  • Emphasis on critical thinking, communication and efficiency
  • Wide variety of experiences with patients of different backgrounds and conditions
  • Smaller patient-to-nurse ratio than a typical hospital floor
  • Strong sense of teamwork among step-down nurses in the same ward

Challenges of being a step-down nurse

While step-down nursing can be a rewarding job, it also has its own unique set of challenges, including:

  • Fast-paced work environment, as patients are constantly in need of care
  • Heavier workload than other hospital units, including intensive care
  • Work hours can vary and often include overtime and night shifts
  • Emotional and physical demands of performing life saving care

Related: Is It Hard To Become a Nurse?

Skills for step-down nursing

Here are some of the most important skills a step-down nurse should have:

  • Communication: Step-down nurses communicate with patients, families and many other medical professionals constantly. Having excellent communication skills helps them explain procedures to patients and describe symptoms to the medical team.

  • Medical knowledge: Step-down nurses must have a solid understanding of medical knowledge and terminology in order to accurately treat patients who have many different conditions.

  • Empathy: Step-down nurses work primarily with patients who require heightened medical care. Displaying a sense of compassion for patients who may be experiencing discomfort can help them provide the best care possible.

  • Organization: Any sort of medical care requires attention to detail and organization skills. For step-down nurses, this is especially true, as they must be able to keep track of their different patients, administer medications and make note of any changes that arise.

  • Agility: With such demanding duties, step-down nurses must be able to multitask while still providing top-quality medical care to their patients. They should be able to make rounds, update charts, speak with patients and medical professionals and organize multiple patients' paperwork.

Related: Skills in Nursing: Definition and Examples

Education requirements for step-down nurses

Like all medical professions, step-down nurses need specialized education and training. Here are the steps necessary for someone interested in pursuing a career in step-down nursing:

Complete a nursing program

All step-down nurses must become licensed registered nurses. In order to become a registered nurse, candidates must earn either an Associate of Science in nursing or a Bachelor of Science in nursing. Many hospitals prefer candidates with a bachelor's degree, since they usually receive more education and training.

Take the NCLEX-RN and apply for a license

All prospective nurses are required to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN). This multiple-choice exam can vary in length depending on your answers. The questions can change based on if you respond correctly.

After passing the exam, you can apply for your RN license. Each state has different requirements, so check with your state's nursing board before you apply to prepare your application. You also need to renew your license according to your state's guidelines.

Learn more about step-down nursing through on-the-job experience

Once you meet the education and licensing requirements, you can begin applying for jobs. Many hospitals offer internships and job opportunities for recent graduates and new RNs, allowing for them to obtain on-the-job experience in the field prior to becoming specialized in step-down nursing. You typically need at least a year of experience before specializing.

Become a Progressive Care Certified Nurse (PCCN)

Most hospitals require that step-down nurses become certified specifically in progressive care, known as a Progressive Care Certified Nurse (PCNN). Candidates can choose between a two- or five-year program, where they must spend up to 2,000 documented hours gaining experience. The purpose of becoming a PCNN is to ensure that step-down you're prepared for caring for very ill patients.

Related: 62 Types of Nurses: The Most In-Demand and Highest-Paying Nursing Specialties

Average salary for a step-down nurse

There's no exact salary information for step-down nurses. Here are some salaries for related roles:


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