Step-down/PCU jobs for Registered Nurses involve the care of patients who require close monitoring and frequent assessment, but who aren't unstable enough to need ICU care. Many Step-down/PCU patients receive complex medications that may require titration based on the vital signs. Many Step-down/PCU patients receive complex medications that may require titration based on the vital signs. The PCU/Intermediate Care Unit RN is sometimes also called a step-down nurse and the PCU is also known as cardiac step-down, medical step-down, neuro step-down, surgical step-down and ER holding.


Evaluate and monitor patient’s progress, exceptional assessment skills

Identify sudden or subtle changes in the patient’s medical condition

Calculating drug dosage, titrating medication doses, administering continuous medication infusion and monitoring patients for effects of medication

Maintain patient hemodynamic stability with proper nursing interventions as ordered

Working closely and collaborating with physcians and all other healthcare providers

Prepares, administers and records any additional prescribed medications

Prepares equipment and assist the physician with bedside procedures

Monitoring patients before, during, and after invasive procedures

Provide emotional support to acutely ill patients and their families.

Recognizing the signs and symptoms of cardiopulmonary and respiratory emergencies and knowing how to start standard interventions to stabilize the patient

Recording symptoms, reactions, and progress

Developing, planning, implementing, evaluating, documenting, and managing nursing care

Patient and family education skills

Consults and coordinates with health care team members to assess, plan, implement and evaluate patient care plans 

Changes dressings, inserts catheters, starts IVs  

Records all care information concisely, accurately and completely, in a timely manner, in the appropriate format and on the appropriate forms 

Performs other position-related duties as assigned, depending on assignment setting 


  • 8+ months of recent working experience as a RN in a Step-down/Progressive Care/Intermediate Care Unit, ER, or ICU (not including clinical rotations) 

  • Current BLS and ACLS Certifications (PALS required for pediatric patients)

  • Current TB Screen

  • Active/Unencumbered State Nursing license

  • Valid Photo Identification/Driver's License

  • Successful completion of a Background Check and Medely's screening process

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