Step-Down Nurse: In-Demand Specialty for Travel Nursing Jobs

July 20, 2021

Sometimes called a progressive care nurse, a telemetry nurse, or an intermediation or transitional care nurse, step-down nurses provide transitional care between the intensive care unit and the med/surg unit. Some patients may be improving and transitioning out of intensive care while others may be moving from med/surg units because they are deteriorating and require a higher intensity of nursing.

Progressive care units are a relatively new development in hospital careand provide both improved patient outcomes and economic benefits. As a result there is expected to be a constantly increasing need for step-down nurses with acute care skills and experience. This is especially true in light of the national nursing shortage and the aging of the population.

RNs can earn up to $2,300 a week as a travel nurse. Speak to a recruiter today!

What is a Step-Down Nurse?

Step-down nurses provide patient care in transitional units where patients are too sick for the med-surg floor but not sick enough for intensive care. Their comprehensive medical and nursing knowledge is supplemented by technical familiarity with advanced telemetry equipment, competence with emergent situations. They provide this care in an environment with a higher nurse-to-patient ratio then is true in critical care units.

Step-down nurses must be familiar with the equipment used to gauge bodily systems and be able to respond quickly to emergent situations. Their responsibilities are generally guided by the individual patient needs. Generally speaking, each patient in a step-down unit is considered medically unstable enough to require close monitoring and frequent assessment of their condition.

They may provide care to transitioning cardiac patients, neuro patients, surgical patients or ER patients, as well as to those with chronic illnesses whose medical needs are increasing. In order to meet the needs of these patients, step-down nurses should be skilled in pulmonary interventions, weaning patients off of mechanical ventilation, extensive wound management and managing patients with arterial catheters, ventricular assist devices, and temporary pacemakers. These patients are often at risk of infection and pressure ulcers. They may be experiencing profound neuromuscular weakness, neuroendocrine changes or brain dysfunctions.

The demands placed on a step-down nurse vary. Some cases step-down nurses work within the critical care or intensive care unit, in an area specifically dedicated to patients with less critical needs. Some work in general progressive care units, while others work in units dedicated to patients with cardiology or neurosurgery needs. Despite this variability, the daily activities of a step-down nurse often include:

  • Monitoring patients for signs of life-threatening complications
  • Managing patients and assisting physicians with ventilators, tracheostomies, arterial lines, IVs, central lines, IV pumps, syringe pumps, PD catheters, Foley catheters, G-tubes, NG-tubes
  • EKG monitoring
  • Post-op care
  • Providing care for 2-4 patients ranging from young adult to geriatric
  • Responding to code blue and rapid response alerts
  • Titration of critical drips
  • Acting as advocate for patients and as a liaison between patient, family and the healthcare team

Step-Down Nurse Salary and Job Growth Potential

Step-down nurses are among the best compensated Registered Nurse specialties. According to, the national average salary for a step-down nurse is $97,216, with some progressive care nurses reportedly earning as much as $146,500.

The amount of compensation a step-down nurse can earn will vary depending on factors including the individual nurse’s level of education and experience, the type of facility and where it is located, and whether the nurse has earned her PCCN or other critical care certifications.

Total income can also be affected by volunteering for overtime and shift differentials. Income can also be enhanced with generous employee benefits such as onsite childcare and health benefits.

The national average salary for a step-down nurse is $96, 916.

As the popularity of progressive care units grows, hospitals will need to recruit more step-down nurses. Combined with the existing nursing shortage, step-down nurses with high-level skills and experience will be in increasing demand all across the country. Many of these facilities are relying upon travel step-down nurses to support their staffing.

Top Paying Cities for Step-Down Nurses in 2021

According to, here are the best paying cities for case management nurses in 2021:

  1. San Francisco, CA: $121,276 per year
  2. Fremont, CA: $116,342 per year
  3. San Jose, CA: $113,450 per year
  4. Oakland, CA: $112,197 per year
  5. Tanaina, AK: $111,845 per year

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Step-Down Nurse Education Requirements, Certifications and Professional Groups

The essential skills a step-down nurse applies to her role are frequently learned on-the-job, but they build upon the foundational nursing education received while becoming a Registered Nurse. Hospitals accept Registered Nurses who have graduated with an Associate’s Degree in Nursing, though many are moving towards a hiring strategy that gives preference to nurses with a Bachelor of Science in Nursing. Following graduation, all RN candidates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam in order to be licensed and considered for a position as a step-down nurse.

Though patients in progressive care units are not as unstable as those in intensive care units, they are still acutely ill. As a result, step-down nurses need the same skills and capabilities as intensive care nurses. The American Association of Critical Care Nurses offers different critical care nursing certifications reflecting this level of knowledge, as well as a Progressive Care Nursing certification (PCCN) specific to the role of a step-down nurse. The certification offers both a two-year option with a requirement of 1,750 hours in direct care of acutely ill adult patients during the previous two years, and a five-year option with a requirement of at least five years with a minimum of 2,000 hours spent caring for acutely ill adult patients.

Step-down nurses interested in networking and advancing themselves may benefit from membership in the American Association of Critical Care Nurses, which hosts educational events, including conferences and webinars.

The Pros and Cons of Being a Step-Down Nurse

Pros of Step-Down Nursing

  • Satisfaction of being part of a collaborative healthcare team working to help patients to improve
  • Ability to work with smaller number of patients. Patient-to-nurse ratio is generally 4:1
  • Ability to work with patients with a variety of conditions, constantly expanding knowledge and skills
  • Job highlights critical thinking skills, organizational skills and communication skills

Cons of Step-Down Nursing

  • Patients are unstable very ill and require a great deal of monitoring, assistance and support
  • Frequently required to work overtime or night shift
  • Workload is heavier than in Intensive Care Unit and patients frequently require more attention
  • Patients transitioning from med-surg are deteriorating rather than improving

Travel Nursing as a Travel Step-Down Nurse

Because step-down nurses can work in a range of settings and provide care for patients with varying conditions, there is a great deal to be learned by moving between facilities. Each progressive care unit operates a little differently, and travel step-down nurses have the opportunity to share their own knowledge and to learn something new in each facility.

In addition to expanding their knowledge, travel step-down nurses enjoy generous compensation with tax-advantaged bonuses and allowances for housing and travel.

Travel nursing carries a lot of benefits. You’ll have the chance to meet new colleagues, make new friends, and visit interesting places. The ability to choose your destination and assignment length provides tremendous flexibility, while the journeys and assignments you select add tremendous interest and variety to an already fulfilling and gratifying career.

RNs can earn up to $2,300 a week as a travel nurse. Speak to a recruiter today!

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