Some hospital patients who leave the intensive-care unit still need constant monitoring and may be transferred to a step-down unit. There, patients' heart rate and rhythm, blood pressure, blood oxygen, respiration and medical conditions receive close attention.

Regency Hospital in Golden Valley is a long-term, acute-care hospital that has a step-down unit as well. "We see a whole range of patients, from those who require extended ventilator and ICU care to those who have had difficulty with healing wounds and have complex medication regimens and comorbidities," explains Rebecca Wong, Regency's director of clinical services.

Nurses need specialized training

Nurses must take electrocardiogram training at the hospital, and 64 hours of an online training program by the American Association of Critical Care Nurses, plus additional didactic training, Wong says.

Other step-down staff includes respiratory therapists, monitor technicians, certified nursing assistants, physical, occupational and speech therapists, wound-care nurses, dieticians, case managers, social workers and pharmacists, according to Wong.

Hennepin County Medical Center has a 12-bed step-down unit within its 48-bed surgery/trauma/neurology unit (STNU). The STNU has 75 registered nurses and 30 healthcare assistants, also known as nursing assistants.

STNU patients may have been in motor vehicle or motorcycle accidents, falls, or have suffered strokes, seizures or spinal cord injuries, according to Sandie Cochran, clinical educator for the STNU.

To work in the unit, nurses must take electrocardiogram training at Hennepin or another area hospital, plus extra training in medication administration. They also must have advanced cardiac life support training, which is offered at Hennepin.

"When we interview new grads, they are often very interested in our unit because they learn the foundation of their skills to work on a surgical unit, but they can also gain skills to work on an intermediate step-down unit," adds Jackie Gleason-Helmeke, one of two nurse managers of Hennepin's STNU. "If they have any interest in going into ICU or ER, the training on the intermediate care unit really provides them with a higher level of care."

Other training options

Wound Ostomy Continence (WOC/ET) nurses need a bachelor's degree and specialized education, which they may take online through the webWOC Nursing Education Program, offered in partnership with the College of Nursing and Health Sciences at Metropolitan State University in St. Paul. The program includes 16 weeks of online theory classes and 150 hours of supervised clinical experience. Graduates may obtain certification from the Wound Ostomy Continence Nurses Society ( For information on webWOC, visit

Classes for nursing assistants are offered at a variety of sites throughout Minnesota. For a listing of sites by the state Department of Health, visit

Nancy Crotti is a freelance writer who lives in St. Paul.