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Become A Step-Down Nurse

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Working As A Step-Down Nurse

  • Assisting and Caring for Others
  • Documenting/Recording Information
  • Getting Information
  • Making Decisions and Solving Problems
  • Updating and Using Relevant Knowledge
  • Deal with People

  • Unpleasant/Angry People

  • Unpleasant/Hazardous Environment

  • Make Decisions

  • $74,000

    Average Salary

What Does A Step-Down Nurse Do

Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.


Registered nurses typically do the following:

  • Record patients’ medical histories and symptoms
  • Administer patients’ medicines and treatments
  • Set up plans for patients’ care or contribute to existing plans
  • Observe patients and record the observations
  • Consult and collaborate with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze the results
  • Teach patients and their families how to manage illnesses or injuries
  • Explain what to do at home after treatment

Most registered nurses work as part of a team with physicians and other healthcare specialists. Some registered nurses oversee licensed practical nurses, nursing assistants, and home health aides.

Registered nurses’ duties and titles often depend on where they work and the patients they work with. For example, an oncology nurse may work with cancer patients or a geriatric nurse may work with elderly patients. Some registered nurses combine one or more areas of practice. For example, a pediatric oncology nurse works with children and teens who have cancer.

Many possibilities for working with specific patient groups exist. The following list includes just a few examples:

Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, and other substances.

Cardiovascular nurses care for patients with heart disease and people who have had heart surgery.

Critical care nurses work in intensive-care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need very close monitoring and treatment.

Genetics nurses provide screening, counseling, and treatment for patients with genetic disorders, such as cystic fibrosis.

Neonatology nurses take care of newborn babies.

Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.

Rehabilitation nurses care for patients with temporary or permanent disabilities.

Registered nurses may work to promote public health, by educating people on warning signs and symptoms of disease or managing chronic health conditions. They may also run health screenings, immunization clinics, blood drives, or other community outreach programs. Other nurses staff the health clinics in schools.

Some nurses do not work directly with patients, but they must still have an active registered nurse license. For example, they may work as nurse educators, healthcare consultants, public policy advisors, researchers, hospital administrators, salespeople for pharmaceutical and medical supply companies, or as medical writers and editors.

Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse (APRN). They provide direct patient care in one of many nursing specialties, such as psychiatric-mental health or pediatrics. CNSs also provide indirect care, by working with other nurses and various other staff to improve the quality of care that patients receive. They often serve in leadership roles and may educate and advise other nursing staff. CNSs also may conduct research and may advocate for certain policies.

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How To Become A Step-Down Nurse

Registered nurses usually take one of three education paths: a Bachelor of Science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an approved nursing program. Registered nurses also must be licensed.


In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and behavioral sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; ADN and diploma programs usually take 2 to 3 years to complete. All programs include supervised clinical experience.

Bachelor’s degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor’s degree or higher is often necessary for administrative positions, research, consulting, and teaching.

Generally, licensed graduates of any of the three types of education programs (bachelor’s, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor’s degree.

Many registered nurses with an ADN or diploma choose to go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and accelerated programs for those who wish to enter the nursing profession and already hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.

Clinical nurse specialists (CNSs) must earn a master’s degree in nursing and typically already have 1 or more years of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree.

Licenses, Certifications, and Registrations

In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN).

Other requirements for licensing vary by state. Each state’s board of nursing can give details. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing.

Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers require it.

CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements.

Important Qualities

Critical-thinking skills. Registered nurses must be able to assess changes in the health status of patients, including determining when to take corrective action and when to make referrals.

Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and assess their health conditions. Nurses need to explain instructions, such as how to take medication, clearly. They must be able to work in teams with other health professionals and communicate the patients’ needs.

Compassion. Registered nurses should be caring and empathetic when caring for patients.

Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time.

Emotional stability. Registered nurses need emotional resilience and the ability to manage their emotions to cope with human suffering, emergencies, and other stresses.

Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given appropriate care.

Physical stamina. Nurses should be comfortable performing physical tasks, such as moving patients. They may be on their feet for most of their shift.


Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuous education, they can move to other settings or be promoted to positions with more responsibility.

In management, nurses can advance from assistant clinical nurse manager, charge nurse, or head nurse to more senior-level administrative roles, such as assistant director or director of nursing, vice president of nursing, or chief nursing officer. Increasingly, management-level nursing positions are requiring a graduate degree in nursing or health services administration. Administrative positions require leadership, communication skills, negotiation skills, and good judgment.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.

Some RNs choose to become nurse anesthetists, nurse midwives, or nurse practitioners, which, along with clinical nurse specialists, are types of advanced practice registered nurses (APRNs). APRNs may provide primary and specialty care, and in many states they may prescribe medications.

Other nurses work as postsecondary teachers in colleges and universities.

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Step-Down Nurse Career Paths

Step-Down Nurse
Staff Nurse Registered Nurse Supervisor
Nurse Manager
9 Yearsyrs
Staff Nurse Registered Nurse Supervisor Registered Nurse Case Manager
Assistant Director Of Nursing
7 Yearsyrs
Staff Nurse Registered Nurse Supervisor Nursing Director
Chief Nursing Officer
13 Yearsyrs
Registered Nurse Consultant Nurse Nursing Director
Director Of Health Services
10 Yearsyrs
Registered Nurse Senior Technician Specialist Nursing Director
Wellness Director
7 Yearsyrs
Registered Nurse Instructor Therapist
Clinical Care Manager
9 Yearsyrs
Nurse Clinical Coordinator Nurse Manager
Nursing Services Manager
10 Yearsyrs
Nurse Head Nurse Nurse Manager
Emergency Services Director
10 Yearsyrs
Nurse Consultant Nurse Assistant Director Of Nursing
Director Of Staff Development
7 Yearsyrs
Clinical Research Nurse Clinical Coordinator Clinical Manager
Manager Of Clinical Services
10 Yearsyrs
Clinical Research Nurse Clinic Registered Nurse Nurse Manager
Patient Relations Director
10 Yearsyrs
Clinical Research Nurse School Nurse Registered Nurse Case Manager
Hospice Director
12 Yearsyrs
Intensive Care Unit Nurse School Nurse Licensed Practical Nurse/Supervisor
Resident Services Director
6 Yearsyrs
Critical Care Nurse Consultant Nurse Assistant Director Of Nursing
Director Of Clinical Education
11 Yearsyrs
Family Nurse Practitioner Clinical Manager Director Of Health Services
Home Service Director
7 Yearsyrs
Intensive Care Unit Nurse Occupational Health Nurse Health Coach
Wellness Manager
7 Yearsyrs
Family Nurse Practitioner Clinical Manager Medical Director
Inpatient Services Director
12 Yearsyrs
Emergency Room Nurse Ambulatory Care Coordinator Social Work Case Manager
Geriatric Care Manager
9 Yearsyrs
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Average Length of Employment
Staff Nurse 6.0 years
Registered Nurse 5.3 years
Head Nurse 4.5 years
Vascular Nurse 4.4 years
Nurse Clinician 4.3 years
Pediatric Nurse 3.5 years
Surgical Nurse 3.4 years
Step-Down Nurse 3.0 years
Telemetry Nurse 2.9 years
Traveling Nurse 2.1 years
Nurse Extern 0.9 years
Top Careers Before Step-Down Nurse
Staff Nurse 22.1%
Nurse 11.7%
Top Careers After Step-Down Nurse
Staff Nurse 15.9%
Nurse 14.7%

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Top Skills for A Step-Down Nurse

  1. Patient Care
  2. Charge Nurse
  3. Telemetry
You can check out examples of real life uses of top skills on resumes here:
  • Direct patient care including physical assessments, medication administration, and nursing procedures.
  • Charge Nurse overseeing professional/nonprofessional FTEE to provide patient care.
  • Served as charge nurse caring for generalized medical/surgical and neurological/telemetry step down patients.
  • Interpreted laboratory results and cardiac tests, and proactively educated patients in health promotion and disease prevention.
  • Provided direct care for cardiac patient population including post cardiac and thoracic surgery and a variety of cardiovascular disease processes.

Step-Down Nurse Demographics










Black or African American


Hispanic or Latino





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Foreign Languages Spoken








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Step-Down Nurse Education


University of Phoenix


Walden University


Ohio University -


Chamberlain College of Nursing


West Virginia University


University of Texas at Arlington


College of Mount Saint Vincent


Mercy College of Ohio


Kaplan University


Methodist Hospital School of Nursing


Columbia University


Old Dominion University


University of Utah


Purdue University


University of Delaware


Catholic University of America


Western Governors University


Central Connecticut State University


University of Pennsylvania


Virginia Commonwealth University

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Family Practice Nursing


Nursing Science






Information Systems




Nursing Assistants


Health/Medical Preparatory Programs


Health Care Administration


General Studies




School Counseling


General Education, Specific Areas


Health Education


Military Applied Sciences


Clinical Psychology


Apparel And Textiles


Veterinary Science


Public Health

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