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Step Down Rn Jobs in California (NOW HIRING)

Slate Healthcare

Travel Telemetry/Step-down RN

Bakersfield, CA · On-site

$2.0K - $2.8K/wk

Slate Healthcare is seeking a travel nurse RN Telemetry PCU - Progressive Care Unit for a travel nursing job in Bakersfield, California. & Requirements * Specialty: Telemetry PCU - Progressive Care ...

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Step Down Rn information

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How much do step down rn jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for step down rn in California is $47.58, according to ZipRecruiter salary data. Most workers in this role earn between $39.78 and $55.79 per hour, depending on experience, location, and employer.

What is a Step Down RN?

Step Down RNs are registered nurses who work in step-down units, which are transitional care areas between the intensive care unit (ICU) and general medical-surgical floors. These nurses care for patients who require close monitoring and specialized care but are not as critically ill as those in the ICU. Step Down RNs monitor vital signs, administer medications, manage care plans, and respond to changes in patient conditions. Their role is crucial in helping patients recover and transition to lower levels of care safely.

What skills and qualifications are needed to be a Step Down RN?

To thrive as a Step Down RN, you need a strong clinical background in acute and progressive care, typically supported by an active RN license and experience in critical or intermediate care settings. Familiarity with cardiac monitors, electronic health records (EHRs), and advanced life support certifications (such as ACLS) is often required. Excellent critical thinking, communication, and teamwork skills help nurses respond to rapidly changing patient conditions and coordinate with multidisciplinary teams. These competencies are vital to ensure patient safety, timely interventions, and optimal recovery in this high-acuity care environment.

How does a Step Down RN collaborate with other healthcare professionals?

Step Down RNs work closely with a multidisciplinary team, including physicians, respiratory therapists, physical therapists, and case managers, to coordinate patient care. They play a vital role in monitoring patients who require more intensive observation than a general medical-surgical floor but not as much as in the ICU. Effective communication and detailed handoffs are essential, as Step Down RNs often advocate for their patients during care plan meetings and rounds. This collaboration helps ensure that changes in patient status are addressed promptly and that each patient's transition to a lower level of care is safe and well-managed.

What is the difference between Step Down Rn vs Med-Surg Nurse?

AspectStep Down RnMed-Surg Nurse
CertificationsRN license, possibly CCRN or specialty certificationsRN license, often no specialty certification required
Work EnvironmentIntermediate to high-acuity units, closer patient monitoringGeneral medical-surgical units, lower acuity
Patient Care FocusPatients with complex, unstable conditionsPatients with less critical, stable conditions
Typical EmployerHospitals with step-down or progressive care unitsGeneral hospitals, medical-surgical wards

Step Down Rns and Med-Surg Nurses both provide vital patient care but differ mainly in patient acuity and required certifications. Step Down Rns handle more complex cases in intermediate care units, requiring specialized skills and certifications, while Med-Surg Nurses work in general wards with less critical patients. Understanding these differences helps in choosing the right career path or job opportunity.

Do step down RNs get paid more?

Step down RNs typically earn higher salaries than staff RNs due to the specialized skills, increased responsibilities, and critical care environment involved. Their compensation may also reflect additional certifications such as CCRN and experience in intensive care settings.

What cities in California are hiring for Step Down Rn jobs?

Cities in California with the most Step Down Rn job openings:

Step Down Rn jobs near you
Infographic showing various Step Down Rn job openings in California as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $98,975 per year, or $47.6 per hour.

RN II-SDU - Step Down Unit

San Luis Obispo, CA • On-site

Talented Medical Solutions
Outpatient Health Care • 11 - 50 employees
Learn more about Talented Medical Solutionsexternal

$2.1K - $2.2K/wk

Contractor

Re-posted 11 days ago

Key responsibilities

  • Provide nursing care to patients in the step down unit, including routine and emergent interventions.

  • Interpret ECG rhythms and manage patient care during life-threatening emergencies.

  • Supervise and delegate care responsibilities to ancillary personnel based on their scope of practice.

Job description

Job Summary

RN II-SDU - Step Down Unit

Talented Medical Solutions

Contract

In-Office | San Luis Obispo, CA, United States


Night Shift 1900 - 0730. Need ACLS. Float to MS if needed.

Nestled on the Central California Coast, Sierra Vista has been providing care to our community since 1959. Our 162-bed acute care facility includes a Level III Neonatal Intensive Care Unit and county designated trauma center. San Luis Obispo offers the excitement of a lively community while being a fifteen-minute drive from the serenity of Avila Beach, known for their natural hot springs, and Pismo Beach, known for their sand dunes and eucalyptus trees. Featuring a charming downtown, comfortable coastal weather, idyllic views, and an active lifestyle San Luis Obispo offers much to be had.

Job Summary:

Responsible for the planning and provision of nursing care to patients in the step down unit.

Accurately interprets ECG rhythm and manages care of patients during life threatening emergencies in populations served.

Supervises and delegates care responsibilities to ancillary personnel commensurate with their scope of practice.

This position is represented by CNA.

Job Requirements:

Education and Work Experience: Associate Degree(A.S.) or equivalent: Required

Bachelor's Degree in Nursing: Preferred

Successful completion of Basic Dysrhythmia Course: Preferred

Completion of Critical Care Course: Preferred

6 months of cardiac step-down or telemetry experience in last 2 years: Preferred

Licenses/Certifications: Current RN license in state of practice: Required

Basic Life Support (BLS) certification from approved vendor per AH policy: Required

Advanced Cardiovascular Life Support (ACLS) certification from approved vendor per AH policy: Required

NIHSS certification: Required within 6 months of hire

Registered Nurse (RN) license in state of practice: Required

NIH Stroke Scale (NIHSS): Required

Facility Specific License/Certifications: Basic Life Support (BLS) certification from approved vendor per AH policy: Required

AHA-ACLS or ARC-ALS: Required

Essential Functions:

Provides appropriate nursing interventions in stable and emergent patient situations.

Is competent in all routine nursing skills including: (1) medication administration, (2) intravenous therapy including blood products, (3) care & maintenance of indwelling catheters & drains and, (4) safe use of any medical equipment used in the critical care setting, (5) Understands and follows chain of command per policy.

Accurately interprets ECG rhythm and manages care of patients during life threatening emergencies in populations served.

Verifies alarm settings with Monitor Technician according to policy.

Demonstrates knowledge of lead functions and application, able to make recommendations for best monitoring based on patient presentation.

Demonstrates knowledge & skills in the care and management of patients post coronary intervention requiring femoral sheath removal with use of Femostop Device.

Demonstrates knowledge & skills in the care and management of patients post permanent pacemaker placement; post AICD placement, and patients admitted with stable acute coronary syndrome.

Demonstrates appropriate clinical judgment in managing cardiac step-down /telemetry patients in the integration of clinical data with clinical assessment.

Initiates a multidisciplinary, goal oriented care plan for each pt in collaboration with members of the health care team and documents education provided to patients and/or families using teaching methods appropriate to population served.

Delegates patient care tasks to ancillary personnel based on individual competency and scope of practice.

Evaluates effectiveness of care performed.

Completes legible, accurate and timely documentation of all nursing care provided, including evaluation of patient's response to medications, treatments & procedures.

Consistently performs necessary unit specific safety & quality control checks (i.e. Shift and 24hr MD order checks, VO/TO Read Back, crash cart checks, urine QC, refrig logs & outdate checks).

Identifies and communicates opportunities to improve care, services, and unit operation.

Tries new approaches to problem solving, is open to change and reaching new goals for the unit.

Performs other job-related duties as assigned.

Organizational Requirements:

Our facility is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

"Hospital Total Bed Count: 162 Unit Bed Count: 27 Staffing on Unit: Based on the ratio of patient care and the number of patients. It is a blended unit. The step-down level patients have a 3:1RN ratio, and the telemetry level patients have a 4:1 RN ratio. Average census is 25% Step down level patients and 75% telemetry level patients. CNAs have an approximately 10:1 CNA Ratio Unit Secretary 10 am-2200 24/7 Monitor Tech Call Required? No call Floating to other units Required? Float to med surg and it depends on staffing and census. Happens often. Weekend Coverage Required? Yes, staff must work 4 weekend shifts in a 6-week period. Weekends on Days are Saturday and Sunday, and weekend obligations on nights are Friday and Saturday PM shift. Medication System: Pyxis, Omnicell, Other : Omnicell EMR System: Cerner/Epic IV Teams: no Lift Teams: Yes 6am-midnight daily. Pharmacy Hours: M-F 6am-2100, Weekends 8am-1800,Off-site pharmacy contract for after-hours. Phlebotomy available on unit? 24:7 phlebotomists. Transport Team: No Provider Coverage: Intensivist: 6 am-1800pm in-house. 18-06 on call at Sierra Vista and French Hospital (a hospital 1.5 miles away). The contract requires the intensivist to be in-house at either facility during those hours. Hospitalist: 24/7 Hospitalist coverage Scrubs: No color requirement. The step-down/telemetry unit is a blended unit that has a combination of 3:1 and 4:1 patient. The 3:1 patient population is intermediate care and includes IV drips such as Cardizem, amiodarone, Cardene, insulin, and the capability to care for patients on high levels of oxygen. The sdu/tele patients have a high focus on neuro trauma patients, complex post-operative patients, and stroke patients. It is a fast pace unit and the busiest admission, transfer, discharge patient unit in the hospital. "