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Step Down Unit Rn information

See Raleigh, NC salary details

$37.9K

$70.4K

$99.2K

How much do step down unit rn jobs pay per year?

As of Jul 14, 2026, the average yearly pay for step down unit rn in Raleigh, NC is $70,379.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,100.00 and $67,600.00 per year, depending on experience, location, and employer.

What are Step Down Unit RNs?

Step Down Unit RNs are registered nurses who care for patients who require more attention than those on a general medical-surgical floor but are not critical enough for the intensive care unit (ICU). They monitor patients closely, administer medications, and respond quickly to changes in condition. Step Down Unit RNs often work with patients recovering from surgery, cardiac events, or severe illnesses, providing advanced monitoring and support to help them transition to lower levels of care.

How to make 200,000 a year as a nurse?

To earn $200,000 annually as a Step Down Unit RN, gaining extensive experience, pursuing advanced certifications, and working in high-demand or high-paying regions can help increase income. Specializing in critical care, taking on leadership roles, or working overtime and per diem shifts also contribute to higher earnings.

What is the difference between Step Down Unit Rn vs Medical-Surgical Nurse?

AspectStep Down Unit RnMedical-Surgical Nurse
CredentialsRN license, possibly CCRN or specialty certificationsRN license, often same certifications
Work EnvironmentIntermediate care units, closer patient monitoringGeneral hospital floors, broader patient care
Patient AcuityHigher acuity, more complex casesModerate acuity, routine cases
Job FocusMonitoring critical signs, managing unstable patientsProviding basic nursing care, patient education

The main difference between a Step Down Unit Rn and a Medical-Surgical Nurse lies in patient acuity and care complexity. Step Down Unit Rns handle higher acuity patients requiring closer monitoring, while Medical-Surgical Nurses care for patients with moderate needs. Both roles require an RN license and similar certifications, but the work environment and patient care focus differ significantly.

What does a stepdown RN do?

A stepdown RN provides care to patients who require more monitoring than in a general ward but less than intensive care. They assess patient conditions, administer medications, monitor vital signs, and collaborate with healthcare teams to ensure safe recovery. This role often involves using specialized equipment and requires strong clinical skills and critical thinking.

What are the key skills and qualifications needed to thrive as a Step Down Unit RN, and why are they important?

To thrive as a Step Down Unit RN, you need strong clinical assessment skills, acute care experience, and an active RN license, often with ACLS certification. Familiarity with telemetry monitoring, electronic health records (EHRs), and advanced life support protocols is essential. Excellent communication, critical thinking, and resilience help you manage complex patient needs and collaborate effectively with multidisciplinary teams. These skills and qualities are crucial for ensuring patient safety and optimal outcomes in a high-acuity, fast-paced environment.

How to make $300,000 as a nurse?

Step Down Unit RNs can increase their earnings by gaining specialized certifications, working overtime or extra shifts, and pursuing higher-paying roles such as charge nurse or nurse manager. Working in high-demand areas, gaining experience, and obtaining advanced degrees like a BSN or MSN can also lead to higher salaries, especially in regions with higher pay scales.

How to make an extra 2000 a month as a nurse?

Step Down Unit RNs can increase their income by taking on per diem or overtime shifts, which often pay higher rates, or by working in travel nursing assignments that offer additional stipends. Developing specialized skills or certifications, such as in critical care or advanced cardiac life support, can also qualify for higher-paying roles or bonuses. Additionally, some nurses supplement income through side jobs like telehealth or teaching nursing courses.

What are some common challenges faced by Step Down Unit RNs, and how can they be addressed?

Step Down Unit RNs often manage patients who are too ill for general medical-surgical floors but do not require intensive care, which means rapidly changing patient conditions can present significant challenges. Balancing a higher patient-to-nurse ratio than in the ICU while still providing vigilant monitoring requires strong organizational and prioritization skills. Effective communication with multidisciplinary teams and quick decision-making are essential to ensure patient safety. Many RNs find that actively seeking mentorship, participating in continuing education, and using available support resources can help manage these challenges and support professional growth.
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Step Down Unit Rn jobs near you
Infographic showing various Step Down Unit Rn job openings in Raleigh, NC as of July 2026, with employment types broken down into 2% As Needed, 62% Full Time, 27% Part Time, 5% Temporary, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $70,379 per year, or $33.8 per hour.

Critical Care Physician Assistant - Cardiothoracic Step Down Unit

Dukehealth.org

Durham, NC • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Duke University Hospital Cardiothoracic Surgery Step-Down Unit (SDU) Advanced Practice Provider (APP)

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States. The largest of the four Duke Health hospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

Job Location

Duke University Hospital Heart Center

Job Summary

The Duke University Hospital Cardiothoracic (CT) Surgery Step-Down Unit (SDU) Advanced Practice Provider (APP) provides direct patient care services for complex critically ill Cardiothoracic Surgery and Advanced Heart Failure patients in collaboration with and under the supervision of the cardiothoracic surgeon(s) and medical director of the CT SDU. The APP performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, coordinates the care and discharge of patients, and provides direct patient care services.

Job Duties and Responsibilities
  • Provide/coordinate clinical care for cardiothoracic stepdown surgery patients at Duke Hospital being followed primarily in the Cardiothoracic Step-down setting but also throughout Duke Hospital and clinic through established protocols and under the supervision of the cardiothoracic surgeon or back-up supervising physician who is either on site or available by pager (including the OR, PACU, Step-down units, all inpatient units, ER and clinic setting).
  • In collaboration with attending cardiothoracic surgeon(s) round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of cardiothoracic patient care;
  • Collaborate with residents, fellows and attendings to formulate treatment plans and monitor patient progress;
  • Assess patients for change in status and institute appropriate interventions. Initiates emergency interventions in an effort to stabilize the patient until physician support arrives.
  • Preoperative evaluation; including (but not limited to) establishing diagnosis, and baseline status
  • Postoperative stabilization and management.
  • Develop patient care pathways, protocols and guidelines for the management of specific problems in conjunction with physicians and other members of the health care team.
  • Analyze clinical practice patterns so as to provide the best medical care and to increase effectiveness and efficiency.
  • Communicate verbally and in writing all pertinent patient information to supervising MD, nursing staff, patient resource manager, home health agency, and other relevant healthcare providers.
  • Document in the patient's chart all relevant data including but not limited to results of diagnostic tests; laboratory results; patients' condition and response to therapies/interventions; communications with supervising MD.
  • Utilize prescriptive privileges only for identified patient populations.
  • Prescriptive authority for prescribing, ordering, and or administering drugs; including (but not limited to) schedule II, III, IV, and V drugs and necessary medical devices.
  • Role models competence in all nurse practitioner/physician assistant advanced skills.
Job Eligibility Requirements

Education: PA: Graduate of an ARC-accredited Physician Assistant (PA) program. Master's degree or Doctoral required. NP: Graduate of an accredited MSN or DNP Acute Care Nurse Practitioner (NP) program for adult care.

Certification: PA: PA-C NP: ACNP or AGACNP

Licensure: PA: Current unrestricted medical license issued by the NCMB with authorization to practice as a PA. NP: Current unrestricted RN license issued by or recognized by NCBON with authorization to practice as a NP. Both: Federal and State DEA with unrestricted prescriptive authority

Experience: PA: 1 year's experience as a PA in a relevant clinical area preferred. NP: 1-year NP experience or 2+ years RN experience in a cardiovascular or cardiothoracic surgery unit is preferred*Will consider a new graduate with prior CTICU/CVICU or CTSD RN experience

Physical and Mental Requirements
  • Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant in the state of North Carolina and within the Duke University Health System.
  • Able to independently seek out resources and work collaboratively to solve complex problems
  • Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others.
  • Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up.
  • Able to use fine motor skills
  • Able to record activities, document assessments & interventions; prepare reports and presentations;
  • Able to use computer and learn new software programs
  • Able to provide leadership in clinical area of expertise and in meeting organizational goals
  • Able to navigate the Hospital and DUHS to provide clinical expertise to specific patient populations
  • Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds
  • Able to remain focused and organized
  • Able to work collaboratively with all levels of personnel
Job Hours

Primary hours fourteen (12) hour shifts/month, rotating shifts, 7 days per week including holidays.

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