Step-down nurse monitoring a patient

You may have been a registered nurse for years, or you’re just beginning to explore careers in nursing. In either case, working in step-down nursing could be the perfect fit for you if you have a passion for supporting patients in critical condition. 

Step-down units (SDUs), also known as progressive care units (PCUs), provide intermediate-level care to patients transitioning from the ICU to a general medical-surgical floor. You can also find step-down nurses in rehabilitation facilities, which treat long-term patients on the mend from serious injuries or illnesses. 

Patients in step-down units aren’t as ill as those in the ICU, but they still aren’t stable enough for med-surg. This “in-between” zone of recovery requires specialized care. That’s where step-down nurses come in.

If you love working on a close-knit team of nurses in transitional care, read on to discover how to become a step-down nurse.

What are the steps to becoming a step-down nurse?

Step-down nurses need thorough training to perform their jobs. If you already have an RN license, you can look for step-down unit opportunities near you. If not, don’t worry. We have everything you need to start an exciting career as a step-down nurse laid out below.

1. Earn a nursing degree

Becoming a nurse takes two to four years, depending on what degree you earn; an associate’s in nursing (ADN) takes two years, and it can help you start your career sooner. A four-year bachelor of science in nursing (BSN) gives you additional skills training and courses in nursing theory and research that can help you advance your career more easily.

Many nurses decide to earn their BSNs because they have more job opportunities. Although you can still be a great nurse with an associate’s degree, many employers prefer candidates with bachelor’s degrees because they’ve spent more time in clinical and have more in-depth knowledge.

The choice is yours, and if you opt for an associate’s, you can always apply your degree toward a BSN later. Make sure you choose a nursing program approved by your state’s board of nursing. Look for accreditation from the CCNE.

2. Pass the NCLEX-RN nursing exam

Once you’ve finished nursing school, it’s time to study for the NCLEX-RN exam. The NCLEX is the second-to-last step before you are officially a registered nurse! You will have to follow some study guides and plan ahead for the exam, which consists of up to 140 questions and lasts up to 5 hours.

There are four categories and multiple sub-categories that the NCLEX system will test you on. The main topics of the NCLEX are:

  • How to provide a safe and effective care environment

  • Health promotion and maintenance across care models

  • Physical and mental health throughout care (psychosocial and physiological integrity) 

When it reaches 95% certainty, it generates a pass or fail score. Your results are sent to your state’s nursing board. 

Once you pass the NCLEX, you can complete your RN license application. Then you’re ready to apply for new grad nursing jobs.

3. Gain work experience, preferably in the step-down unit (SDU)

You will need to develop your skills as a nurse to find step-down jobs. Look for step-down nurse residency jobs near you to get on-the-job training. Working alongside experienced PCU nurses will help you learn the ins and outs of progressive care much more easily. 

You’ll need to focus on developing intensive care clinical skills to qualify for step-down nurse jobs. These include:

  • Advanced life support 

  • Airway management (mechanical ventilation, intubation, tracheotomy tubes, and supplemental oxygen)

  • Central line insertion

  • Chest tube drainage care

  • CPR

  • IV drug administration and line management 

  • Telemetry analysis

  • Medication administration of ICU drugs, such as morphine, epinephrine, and lidocaine 

4. Consider taking the PCCN certification to improve job opportunities

PCCN stands for “Progressive Care Certified Nurse,” and it is a great certification to have if you want to specialize in step-down nursing. Your PPCN certification can help you qualify for more jobs in transitional care nursing by demonstrating your knowledge and expertise in progressive care. 

Nurses who earn their PCCN often apply for jobs in step-down units, telemetry units, ICUs, and emergency departments. There is a 2-year and 5-year certification option; you must have at least 1,750 to 2,000 hours in acute care for adult patients and a valid, unencumbered nursing license. 

5. Apply for step-down nurse jobs

With several years of experience and PCCN certification, you’ll be eligible for many step-down nurse jobs in your area. You could also consider becoming a travel step-down nurse. ShiftMed can help you find the perfect nursing jobs that align with your skills, interests, and experience level.

Can you become a step-down nurse online?

Aspiring step-down nurses must complete clinical rotations in person, but they can complete all their academic coursework online. 

Many online nursing degree programs allow students to study on a flexible schedule; however, they need to meet their state’s new nurse requirements at an approved healthcare facility.

The NCLEX requires online nursing degrees to meet the nursing requirements in your state of residency. As long as the minimum requirements are met, you can complete your coursework anywhere in the country. 

What is the difference between a step-down nurse and a registered nurse?

Step-down nurses are registered nurses. The difference between a step-down nurse and a registered nurse is that the former specializes in critical/acute progressive care. They work exclusively with patients with more critical needs than those admitted to a general med-surg floor.

What positions can you progress to from being a step-down nurse?

Step-down nurses can often transfer to different departments with experience in telemetry, ICU, or emergency care. If you want to further your education, you could earn a master’s degree and become a critical care nurse practitioner (CCNP). These professionals can tend to their own patients under the supervision of a physician. Rather than only providing nursing care, they can make diagnoses and prescribe medications.

Do your step-down nurse exam qualifications expire?

Every step-down nurse has to renew their RN license and certifications periodically. Most states require RN license renewal every 3 to 4 years. Certifications can last between 3 and 5 years. It’s important to check your state’s licensing requirements to ensure you remain compliant. 

How long does it take to become a step-down nurse?

On average, becoming a step-down nurse will take around six years. You will need to complete your foundational nursing education, then gain experience and possibly certifications. Once you’ve developed your nursing acumen and built a solid step-down nurse resume, finding jobs that align with your career goals will be easier.

Remember, step-down nursing is a type of critical care. So, it takes a lot of dedication and additional training to truly master. Working with intensive care patients is stressful, and it’s not something new grad nurses are generally prepared to do without some difficulty. 

Be patient with yourself, and take time to gain all the skills and qualifications you need to give your patients the best possible care. You must give yourself enough time to gain the valuable experience needed to work in this role.

Frequently asked questions about becoming a step-down nurse

Is step-down nursing hard?

Step-down nursing has many challenges and care requirements that med-surg nurses don’t confront regularly. PCU patients generally have conditions that require round-the-clock care, like long-term ventilators, tracheotomy tubes, feeding tubes, and cardiac catheters. 

You have to be comfortable working in a fast-paced, demanding environment. It may not be every nurse’s ideal job, but it can be immensely engaging and rewarding if you’re passionate about this type of care. 

What is the typical patient ratio in step-down? 

Most step-down units have a lower patient ratio than med-surg floors due to their higher acuity. You’ll likely see ratios between 1:3-4, depending on the size of the facility you work in. 

Most nurses who work in intensive care have fewer patients than those that work in other wards. 

Is step-down critical care?

Yes, step-down nurses work within a hospital or facility’s greater intensive care ward. They provide transitional care for patients moving from ICU to the general floor. Some step-down nurses have subspecialties in cardiology, pediatrics, or neurosurgery. You can even look for step-down jobs in surgical hospitals, then specialize in a particular branch of medicine.

What is the difference between PCU and step-down?

A progressive care unit (PCU) is what some hospitals call a step-down unit (SDU), but both of them mean the same thing. Patients in progressive care are in the process of transitioning from intensive care to a general med-surg floor.