What made you chose your specialty? I have been in PCU/stepdown for 2 years. Moved to Texas from NY and most of the PCU/step-downs are not as critical as I am used to.

I went from Neuro/Trauma to ICU then to ER and now to Clinic (Native American) after 40+ years time to slow down a little

I worked in Med/Surg for 5 years and felt that I needed to try something

different. I transferred to Medical ICU and I love it

HCA has a great Residency program that offers Didactic training

As well as Preceptorships with experienced Nurses for Neuro ICU

Cardiac ICU as well. I would highly recommend the trainings

Take the Leap of Faith, it's going to stretch you some

But One year later looking back to how far you have grown

You will be thankful that you took the chance

Best of luck

I had breast cancer and wanted to help others with cancer diagnosis and I switched from outpatient surgical to inpatient oncology. I became chemo certified and I love it.

Hi I've been a step-down nurse for over 10 years. Depending on each state and hospital dome patients aren't as sick. I'm from California and most of our step-downs are actually very sick ICU patients. So it really depends on the facility or state. Also some particular patients are in step-down just for a close 24 hour observation before discharge or downgrade

I’ve been working PCU/Stepdown for the last 8 of the 11yrs I’ve been a nurse and I’m bored. I loved how the patient population for this specialty are actually sick and not always cussing you out and telling you where to go lol. Not a huge fan of ICU but since I’m bored and not feeling challenged anymore, I may switch to Cath Lab or PACU. I’ve heard people change specialities several times until settling in and sometimes change again! I say test the waters and see what you would really like but it will be different in every state

They are only step down when administration thinks they should be, otherwise they are big dumps

I had the same problem moving from OH to MD, I just transitioned to ICU so I wasn't bored with low acuity patients. Most smaller hospital ICUs love hiring bigger city PCU nurses because they're used to the patient type they get.

Honestly, it was the only in-person clinical I was able to do due to COVID. I fell in love with the atmosphere of the unit. The level of care the patients required as well as just being intrigued by their surgeries and post-care.

It all depends on where you work, staffing ratios, at my old hospital “step down” was on the same floor as neuro critical care. It all depends on the appropriate placement for patients. Step down units is still intermediate care and need to monitored closely just because a patient isn’t in ICU doesn’t mean they aren’t critical or don’t require close monitoring. Pt’s conditions change constantly, there are RRT/code blue in med/surg, step down, neuro and icu, ER all the time. The priority is to stabilize the patient to be discharged home, we say “step down” is where the patients are critical but have been stabilized and don’t require 1:1 monitoring, but still need to monitored continuously because they can easily be upgraded to ICU if the condition worsens or downgraded to med/surg once the physician and care team are confident the patients condition will not decline. So again It’s really where you work, staffing ratios, what floor, etc. especially if the ICU of at capacity the overflow will go to the step down units so it’s always best to be prepared or apply to a different department if you feel you aren’t experiencing the critical care experience you are seeking. But in my experience everyone is critical but that’s the ER nurse in me 🙂 hope this helps

I chose decided on my specialty while getting experience on a MedSurg floor because I was exposed to everything.

I have noticed that larger , busier cities are higher level care than smaller or especially rural areas. You could consider ICU or ER. If you prefer more time with the patient you could consider a specialty floor: renal, med-surg, or even dialysis. Rehab tends to keep you on your toes tracking down the location of your patients at any given time. My favorite inpatient was stepdown cardia/renal floor in a city of 30000. There tended to be a lot of dual diagnosis and this floor was used as a "catch-all unit, which had opportunity for new skills pretty consistently. I did not choose my favorite right away. I stuck with one unit for a few years then on to the next until I found my sweet spot. now I am pretty happy with my remote job as a Nurse Supervisor. Changes daily and lots of niche opportunities to grow and hone skills like data entry and interpretation, working with Technology is a different place and style altogether but so much fun. next. Now I love being a supervisor working from home!