Whether you’ve been a nurse for many years, or just shrugged off your graduation gown, becoming a step-down traveling nurse provides a great way to see the country while stepping up your career. And working with one of the top travel nursing companies can help get you there.
Stepdown units – also known as progressive care units (PCUs), telemetry, intermediate care and transitional care units – provide a path of safety for patients who were once critically ill, and are trying to make their way home.
As a transition between the ICU and the general nursing floor, nurses on these units provide specialized care to patients who are still pretty sick. Not quite stable enough for med-surg, and not quite ill enough for the ICU, they require close monitoring by expert staff who know how to think critically and intervene rapidly.
Highly trained and highly skilled, RN’s on these units are a combination of seasoned pros and new grads who have undergone advanced training. They work in conjunction with a variety of other healthcare professionals on the unit – including LPN’s, patient care technicians, and monitor technicians, as well as a multidisciplinary team. Since the acuity is so high, and patient conditions can change rapidly, teamwork with clear communication is a must.
Patients here can become unstable in a heartbeat, and require high-frequency monitoring and interventions. They come from a variety of critical care settings, including specialty ICU’s like neurosurgery, trauma, cardiothoracic surgery, and the coronary care unit. Telemetry is typical, as well as a variety of potent cardiac IV infusions. Some units serve patients on ventilators, as well as providing a variety of other invasive therapies, such as cardioversion and chest tubes.
Rebecca Wong, director of clinical services at Regency Hospital, describes the patient mix on a stepdown unit: “We see a whole range of patients, from those who require extended ventilator and ICU care to those who have had difficulty with healing wounds and have complex medication regimens and comorbidities.”
Although new grads are welcome, they’ll need to undergo specialized training, as will seasoned nurses, if they don’t already have a critical care background. Nursing newbies with an eye on the ICU or ER often seek the valuable skills and experience they’ll get in a stepdown unit as a stepping stone to get there. Typically, the hospital provides whatever training’s needed, or connects nurses with courses provided by the American Association of Critical Care Nurses (AACN). Some of the step-down training topics can include:
According to Michael Jorden, MSN, RN, manager of the Cardiac Stepdown Unit at Vanderbilt University Hospital, “To work in the Cardiac Stepdown unit, our nurses need to be able to provide patient education, have training in rhythm interpretation, and understand the relationship of multiple co-morbidities to care for our patient population.”
Obviously, the very definition of a stepdown unit involves having something to step down from, which would be a critical care unit of some type. So this kind of nursing happens in an acute care hospital for patients who are no longer ICU-eligible, yet not quite ready for the med-surg floor.
Nurses who work in these units enjoy the complexity of care, and the satisfaction that comes from doing that well. There’s a great variety of patients who are ill enough to be a challenge, but usually well enough to participate. Nurses with critical care know-how combined with a penchant for patient empowerment help patients with complex needs move safely along the path toward the comforts of home.
The pace is fast. The caseload higher than the ICU. And the patients often unstable. You’ll need to think critically, intervene accordingly, be a team player and supervise others. If any of that creates a sinking feeling in your gut, you might want to consider looking elsewhere.
There’s been a certification process in place for nurses who work in stepdown units since 2004. Supported by the AACN Certification Corporation, the Progressive Care Nursing (PCCN®) certification is “for nurses providing care to acutely ill adult patients regardless of the geographic location of their nursing care. Nurses interested in this certification may work in such areas as intermediate care, direct observation, stepdown, telemetry, transitional care or emergency departments.”
If you’re experienced, and don’t already have your certification, it’s a great idea for a lot of reasons – like improving care for your patients, giving credibility to your expertise, and putting you at the top of the list with travel nursing agencies.
There’s a lot to say for being light on your feet. If you’re a new grad trying to settle on a specialty and location, joining the ranks of traveling nurses is a great way to test the waters. If you’re experienced and looking for a challenge, you can take your expertise on the road and let it pay you back for all the years you’ve spent building it.
Travel nurses enjoy a lot of benefits – like making great money, meeting great people, and working in great places. Travel nurse agencies have contracts that vary in assignment length, salary, and additional benefit options – such as housing and healthcare coverage.
You can learn more about stepdown nursing (aka progressive care nursing) through the American Association of Critical Care Nurses (AACN). And if you’re interested in learning more about becoming a traveling nurse, check it out. See what other nurses want to know, and even look into available jobs with traveling nurse agencies.
Whether you’re a seasoned pro who’s seen it all, or a new grad who’s about to, work as a traveling stepdown nurse is a great way to sharpen your skills while stepping up your career.
By Sue Montgomery, RN, BSN
Sue Montgomery, RN, BSN is a freelance healthcare writer and professional copywriter. In her 30 years as a registered nurse, Sue has held roles from staff nurse to administrator in critical care, hospice and the health insurance industry.