Step Down Unit vs ICU Nursing: Similarities and Differences

If you’re interested in nursing, you’ve probably heard about ICUs and step-down units. But what exactly are the differences between these two types of units? Both are critical care settings that involve highly specialized skills and responsibilities; however, there can be some stark differences between the two. 

In this blog post, we’ll explore how these two specialties compare based on factors such as the care environment, nurses’ duties, patient population served, and more. Whether you’re already a nurse looking to gain more experience or just starting your nursing journey, this post has something for everyone. 

What is an Intensive Care Unit?

An Intensive Care Unit (ICU) is a specialized hospital area that provides round-the-clock care to critically ill patients. ICUs are equipped with state-of-the-art equipment and staffed by highly trained professionals such as nurses, physicians, respiratory therapists, pharmacists, and other healthcare providers. 

The goal of the ICU is to provide the highest level of care possible to stabilize and monitor severely ill or injured patients. Patients in an ICU are typically those who are suffering from life-threatening conditions such as:

  • Heart attack 
  • Stroke 
  • Trauma
  • Sepsis
  • Multiple organ failure 
  • Other severe medical emergencies

In the ICU setting, nurses are responsible for monitoring a patient’s vital signs, administering medications and treatments, performing procedures, and educating patients and families. Nurses must be familiar with advanced cardiac life support protocols and ventilator management to provide appropriate care. They also need to be able to work collaboratively with other healthcare providers to secure the best outcome for their patients. 

What is a Step-Down Unit? 

A Step-Down Unit (SDU) is an intermediate level of care for patients who are stable enough to be moved out of the ICU but still need specialized monitoring and care. 

Patients in this unit typically have been weaned from ventilators or other critical-care medications and therapies. Nurses in the SDU are responsible for providing direct care to patients, monitoring vitals, administering medications and treatments, and assessing patients’ overall condition. 

The patient population in the SDU is typically not as sick or fragile as those in the ICU. Patients in this unit will generally have either a chronic illness that requires frequent monitoring or have made sufficient progress in their recovery. They no longer need the stage of care provided in an ICU. 

SDU nurses must have a good understanding of medical terminology, pharmacology, and pathophysiology and be able to perform general nursing procedures such as vital symptoms assessments and medication administration. 

Additionally, SDU nurses need to be able to recognize subtle changes in their patient’s condition and take appropriate action. 

Similarities and Differences Between ICU & SDU Nursing 


Although ICU and Step Down Unit settings share some similarities, there are also some differences. Both step-down & ICU settings involve highly specialized skills and responsibilities, but the patient population, care environment, and nurses’ duties can be quite different. 

One similarity between ICU and SDU nursing is that both require high technical skills to provide appropriate patient care. Both also collaborate with other healthcare providers, such as physicians, respiratory therapists, and pharmacists. Additionally, both ICU and SDU nurses must be able to recognize subtle changes in patient conditions and take appropriate action. 


The main difference between ICU and SDU nursing is the patient population each type of nurse cares for. In an ICU, nurses care for severely ill or injured patients, likely on ventilators or other critical-care medications and therapies. In contrast, patients in an SDU are generally not as sick or fragile as those in the ICU but still require specialized care. 

Overall, ICU and Step Down Unit nursing offers rewarding opportunities for nurses looking to specialize in critical care. Both involve technical knowledge and collaboration with other healthcare providers to supply the best care for their patients. Nurses interested in either type of setting must be familiar with their differences to decide which to pursue. 

Work Profile of Nurses in Step-Down Unit Vs ICU

Step-Down Unit

Nurses play an essential role in the Special Duty Unit (SDU). They provide medical assistance to law enforcement officers working in high-risk situations and help ensure their safety. The work of nurses in the SDU involves:

1. Administer medications and treatments as specified by the physician

Step-down nurses must be knowledgeable in administering drugs and treatments prescribed in a patient’s treatment plan. This includes prescription drugs, such as antibiotics, pain relievers, diuretics, and other medications. They must also understand how to properly use medical supplies such as intravenous (IV) pumps and syringes.

2. Assess patient conditions and vital signs

Step-down nurses must assess a patient’s condition on an ongoing basis. This includes monitoring vital signs like heart rate, respiration rate, blood pressure, temperature, and oxygen saturation levels. They must also look for any changes in mental status or behavior that could indicate a change in condition.

3. Provide patient education

Step-down nurses must be able to provide patient education regarding their specific medical conditions and any treatments, medications, or lifestyle changes that are necessary for recovery. They often must collaborate with other healthcare professionals to ensure the patient receives comprehensive care.

4. Monitoring and Evaluating the Patient

Like in the ICU, step-down nurses can monitor their patient’s vital signs and administer medications or treatments as needed. Step-down nurses may also be involved in helping to assess a patient’s response to treatment or progress toward recovery.

5. Provide Education and Assistance

Step-down nurses are also responsible for educating and supporting patients and their families as they transition out of the ICU. This may include teaching them about the wound or medication care, providing resources for follow-up care, or answering questions about their condition.

6. Complete Necessary Paperwork

Step-down nurses may also be responsible for completing the necessary paperwork for transfer out of the unit. This can include creating a referral list, ordering supplies or medications, or providing contact information for follow-up care.

7. Perform wound care

Step-down nurses must be knowledgeable in wound care and skin integrity management. This includes proper bandaging techniques, cleaning and dressing wounds, and educating patients on wound care.

8. Record patient history, treatments, and progress

Finally, step-down nurses must keep accurate and thorough records of each patient’s medical history, treatments, and improvement to provide the best care. This includes taking notes on patient condition changes, maintaining accurate medication records, and recording any treatments or procedures.

These are just some of the responsibilities that a step-down nurse has. While this job can be demanding

9. The Nurses Of SDU Generally Work With the Following Equipment:

The step-down nurse is responsible for operating and maintaining various medical equipment. This includes:

  • Intravenous Drips
  • Mechanical Ventilators
  • Monitors
  • Suction pumps
  • IV Pumps
  • Syringe Pumps
  • Oxygen Therapy Devices
  • Vital Signs Monitors
  • Blood Pressure Cuffs
  • Sedation
  • Therapy Machines (e.g., Physical, Occupational, Speech)

ICU Unit

The job duties of ICU nurses can vary greatly depending on the type of ICU they work in. Generally, however, these nurses care for critically ill patients and provide life-sustaining treatments. 

1. Continue Monitoring and Evaluating the Patient

ICU nurses continuously monitor the condition of their patients. This involves monitoring vital signs, such as heart rate, respiratory rate, blood pressure, oxygen levels, temperature, and glucose level. 

Additionally, they assess any changes in a patient’s mental status or behavior since these can indicate a change in condition. 

2. Administering Treatments: 

ICU nurses must also administer treatments, including injectable medications and intravenous fluids, and monitor their patient’s response to treatment. Depending on their patient’s needs, they may be involved in various other tasks. For example, some ICU nurses are trained to perform certain surgical procedures or provide advanced life support. 

3. Identifying Changes in Patient’s Condition: 

ICU nurses must be able to recognize changes in a patient’s condition and react accordingly. This may include adjusting medications, administering oxygen or other treatments, or notifying the physician of any changes that need to be addressed. 

4. Maintaining Patient Records: 

ICU nurses also have an essential responsibility to maintain accurate patient records. This includes documenting vital signs, medications administered, and other treatments given.

5. Completing Necessary Paperwork:

ICU nurses must also be prepared to complete paperwork to transfer patients out of the ICU. This can include completing discharge instructions, creating a referral list, or providing contact information for follow-up care. 

6. The Nurses of the ICU Generally work with the following equipment:

The ICU nurses are responsible for operating and maintaining various medical equipment. This includes:

  • Ventilators
  • Intra-aortic balloon pumps
  • Monitors
  • Ventricular assist devices
  • Infusion pumps
  • Arterial lines
  • Patient lifts
  • Swan-Ganz catheters
  • Intracranial pressure monitors , and other medical equipment used in the ICU. 

The nurses must be proficient in operating this equipment and keep it clean and regularly maintained to ensure patient safety. Additionally, they may be responsible for stocking medications, supplies, and equipment. 

SDU Vs. ICU Nurses Salary Comparison

Salary for both units are very much similar but ICU nurses got some edge over SDUN. See the Difference below.

Average Salary For Step- Down Unit Nurses

For registered nurses working on the step-down unit, the national average annual salary is a respectable $120,065, offering an hourly wage of $58. However, it’s worth noting that only 25% of registered nurse jobs in this particular field fall below $76,000 per year. Those looking to earn a higher salary may want to consider positions in New York, Idaho, or California, where the average pay is the highest.

Average Salary For ICU Nurses

In comparison, registered nurses in the ICU make an average of $121,963 per year with an hourly wage of $59. To be considered in the top 25% of earners in this field, a nurse must make upwards of $80,000 annually. Overall, these statistics offer helpful insight for those thinking of a career in nursing or looking to advance their professional standing.

Work Environment of Both Units

Hospitals can be stressful workplaces, and the ICU is no exception. While every hospital is different, many ICUs are plagued by physical environmental stressors that make work challenging for nurses and other healthcare professionals. 

ICU Unit

These factors can affect staff morale and patient care, from irritating lighting and annoying noise to awkwardly placed equipment and overcrowding. That said, some measures can be taken to mitigate these challenges. 

For example, many patient rooms now feature more windows or are even entirely glass-fronted, allowing nurses to watch their patients while charting. Similarly, visual and auditory alarms built into patient equipment can ensure that nurses can quickly respond to any issues. 

In the intensive care unit, bedside monitors are crucial for watching each patient’s vital signs. But did you know these monitors are also mirrored to the nurses’ station monitors? 

This allows nurses to closely monitor their patient’s status even when they are not in the room. Some ICUs even have pull-down desks or small cubby-like desks next to per-patient rooms for nurses who must stay closer to their sickest patients. 

While ICUs may have strict visiting hours with locked doors, this can keep the unit quieter – except in emergencies.

Step-Down Unit

While the step-down unit is still a hospital setting, the physical environment tends to be less intense. The patient rooms are usually light and airy, with plenty of windows permitting natural light to flood. 

In addition, most visiting restrictions are relaxed, allowing family members to see their loved ones more often – this can provide an extra layer of comfort for the patient and their families. 

Many step-down units are set up to look just like a typical medical-surgical unit, with patient rooms located down long hallways and nurses’ stations positioned throughout the area.

These stations can vary in size and number, depending on the size of the unit. Still, you’ll typically find a main one with a telemetry center operated by a telemetry nurse.

The nurses’ station also tends to be more relaxed. Without the hustle and bustle of an ICU, there is often more space for nurses to spread out and take breaks when they can. While step-down units still require constant monitoring of patient’s vital signs, much of the work can be done from a desktop computer, meaning nurses don’t have to hover over patients as much. 

Finally, many step-down units are equipped with telemetry units that allow nurses to remotely monitor their patient’s vital signs without constantly entering and exiting rooms. This increases patient care efficiency, freeing nurses to focus on quality care. 

Frequently Asked Questions:

How many patients should an ICU nurse have?

The patient load in an ICU is usually 1 to 2 patients, although some units may have three patients assigned to one nurse depending on staffing levels and severity of care needed.

How many patients should an SDU nurse have?

Most well-staffed step-down units will assign 3 to 4 patients per nurse, which can still keep a nurse busy throughout their Shift. However, nurses may have to care for more patients in understaffed units or during night shifts, making the workload even more challenging.

How many hours Nurses work?

Nurses in most units work 12 hour shifts for 3 days a week with 4 days rest for recovery and rest.

Final Thoughts

In conclusion, the ICU and step-down units offer very different work environments. While both require dedicated individuals to provide quality patient care, the physical and emotional demands of each setting are vastly different.

Nurses must consider these factors before deciding which unit is best suited for them. With the right combination of preparation, education, and dedication, nurses can excel in either setting – ultimately making a positive difference in the lives of their patients.

The best way to find the right fit is to explore each environment and get a feel for what works best for you. With some research, you’ll be able to find the perfect balance of challenge and comfort that will help you thrive in either unit.


1. Prin M, Wunsch H. The role of step-down beds in hospital care. Am J Respir Crit Care Med. 2014 Dec 1;190(11):1210-6. doi: 10.1164/rccm.201406-1117PP. PMID: 25163008; PMCID: PMC4315815.


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