Remember the 2000s era iPhone commercial with the “There’s an App for That” tagline? Let’s put a healthcare spin on that – at Renown Health, there’s a unit for that. Emergency, labor and delivery, pediatric acute care, trauma, surgery, the list goes on.
When it comes to critical care, your mind probably jumps to either the intensive care unit (ICU), emergency room (ER) or a unit that provides care for a more standard hospitalization. But what about the patients who fall in between those two levels of care?
Yep, there’s a unit for that at Renown, too. It’s called the Intermediate Care Unit (IMCU), located on the sixth floor of the Tahoe Tower (T6) at Renown Regional Medical Center, boasting a dedicated team of nurses, physicians, critical care technicians and more.
The IMCU cares for patients who still need close monitoring and specialized care but don't need an ICU stay. Everyone in this department shares common missions: catch early signs of change, intervene swiftly and help patients progress to a lower level of care – and eventually, back home.
Stepping Up for Step-Down Care
So obviously right off the bat, there is always a lot going on in the IMCU, from hearts to heads. No two days are alike, but that’s just the way this team likes it.
“A day in the life on the IMCU is never the same; each shift brings new challenges and a diverse patient population,” said Kayla Smith, RN, Supervisor of Clinical Nursing. “We care for patients across a wide spectrum, including cardiac, neurological, trauma and surgical cases. Whether it’s managing pericardial drains, transvenous pacemakers, lumbar drains or EKOS therapy, we handle a little bit of everything. Our patients may be on vasopressors or stable ventilators, requiring close monitoring and expert care. With a nurse-to-patient ratio of 1:3, every day begins with a thorough report, checking alarm parameters and carefully prioritizing patient needs.”
Renown’s 18-bed IMCU is a “step-down” unit, meaning that patients who were admitted into the ER or ICU can, as the moniker suggests, take a step down into a lower level of critical care. On the flip side, the IMCU also cares for patients from lower-level units who need more monitored care than what they are currently receiving, also called (you guessed it) a “step-up” unit.
“Since we are a step-down unit, we receive many ICU ‘downgrades,’” said Nicolas Poynter, RN, Charge Nurse. “On a daily basis, we admit at least three to six new patients, whether they are ICU downgrades, are emergency department admits or require a higher level of care. Our typical day starts with receiving reports, followed by 8 a.m. assessments and rounds. During the day, everyone helps each other with patient turns, baths, mobilizations, admissions and dual signoffs.”
“As IMCU Hospitalists, we admit patients from the emergency room and care for those downgraded from our ICUs who meet our step-down criteria,” added Stefan Schmidhuber, MD, Hospitalist. “We also manage patients from other units who require an upgrade in care when their condition worsens. After our regular morning rounds, we have interdisciplinary team (IDT) rounds with pharmacy and case management. We are available 24 hours a day, coordinating care to facilitate smooth transitions to the next step in the patient’s healthcare journey.”
When the sun goes down, the night shift moves right in. Before they start their normal duties, they have the responsibility of carefully going through the arrival of patient admissions that often flow in right at the shift change.
“The day starts with a huddle, followed by a bedside report handoff with the night shift; since I mainly work nights, this is usually a very busy time with many patient admissions,” said Desirae Butler, RN. “After the whirlwind of shift change and admits, we review orders and notes. Next, we perform patient assessments, administer medication and provide care to help settle patients into their beds for the night. Afterward, we complete charting. In the morning, we collect labs and pass medications before it’s time to go home. In between all of this, we frequently respond to emergencies throughout the night, working closely alongside our amazing coworkers.”
At Renown, our clinical teams are known for going above and beyond for their patients. The IMCU is no exception. Upholding the highest standards of care is a commitment this department takes seriously. One example of this especially stands out to this team.
“For almost 120 days, the IMCU cared for a patient who was medically and socially very complex,” said Kayla Smith, RN. “The patient was at the end of her life for the majority of the time she was admitted to the IMCU, and she and her family required a lot of support to cope with her new terminal diagnosis as well as now requiring full care for her activities of daily living (ADLs). The IMCU team provided extraordinary care and compassion to the patient and family during their stay.”
“Reducing infections and adverse events while achieving higher satisfaction scores with patients and families makes us all very happy and proud,” added Dr. Schmidhuber.
Caring for patients in the IMCU means facing a constantly changing and unpredictable environment – but don’t worry, because that environment is where these care teams thrive. They are adaptable and ready for whatever the day throws at them.
“Like a box of chocolates, you never know what you’re going to get in the IMCU,” said Nicolas Poynter, RN. “This unit will keep you on your toes and challenge your knowledge every day.”
Not-for-Profit and All-for-You
Like every department at Renown, our mission as a not-for-profit health system stays front and center in the IMCU. This focus fuels this team’s passion and commitment for saving lives and caring for all people.
“Being part of Renown as a not-for-profit health system means so much to me,” said Kayla Smith, RN. “It reminds me every day that the care I provide is about truly making a difference in my patients’ lives. Knowing that the focus is on the community’s well-being inspires me to go the extra mile, listen more closely and advocate fiercely for those I care for. It feels like being part of something bigger—a mission to help people heal and thrive, no matter their background or circumstances. That purpose is what makes coming to work every day so meaningful.”
As a not-for-profit, every dollar we receive is reinvested right back into programs that promote better health for our community, including advanced technologies, expanding specialties, and of course, our own employees. Our mission begins with our people, after all.
Whether our IMCU team members came to this unit from a different floor at Renown or from travel nursing across the country and planting roots in Reno, their career journeys have been nothing short of exciting.
“I started my journey as a nurse apprentice on the third floor of the Tahoe Tower, but I wanted to challenge myself further and apply more critical thinking to my work,” said Nicolas Poynter, RN. “With that goal in mind, I reapplied to the critical care pool and was fortunate to be offered a position in the IMCU as both a nurse apprentice and a new graduate. I was excited about the opportunity to grow, and this role has exceeded my expectations in terms of learning and development. Being in this unit has helped me become a well-rounded nurse, as we often see everything in the book and learn something new from our patients. That challenge has been a key part of my professional growth.”
“I began my nursing career about 10 years ago in telemetry before transferring to an Intermediate Care Unit,” added Kayla Smith, RN. “In 2017, I started travel nursing, which took me to hospitals all over the country working with a variety of specialties, from cardiology and neurology to ear, nose and throat. Traveling gave me a unique opportunity to see different approaches to patient care and broaden my clinical skills. After six years on the road, I settled down here in the IMCU. I love that IMCU allows me to care for seriously ill patients across a wide range of specialties, which keeps every day challenging and rewarding.”
The IMCU attracts healthcare professionals who thrive in a fast-paced environment. For several of these employees, joining the IMCU team is a continuation of years of experience in similar settings, driven by a shared purpose to serve the community with compassionate, patient-centered care.
“I have been involved in ICU and step-down unit work for many years and enjoy the challenge and variety as well as the intermediate acuity of patients,” said Dr. Schmidhuber.
“I chose a career in the IMCU because my experience in nursing is from a very similar unit in West Virginia,” added Desirae Butler, RN. “I love the speed and acuity of the patients on units like this.”
Stepping in where patients need them most during their state of illness is what continues to re-invigorate the passion of everyone on the IMCU.
“It is a privilege to care for patients when help is needed most,” said Dr. Schmidhuber. “To know that we provide care for all and serve the community in that way is very satisfying. It is a good feeling to be able to make a difference for patients in need that would otherwise not get the care they require. I am proud to be part of this challenging task.”
IMCU Wants You!
Ready for your next challenge? Interested in providing care for a diverse array of patients in a high-speed setting? The IMCU might be just the place for you. As a clinician in this department, you’ll be surrounded by supportive team members who will stop at nothing to help you and share your enthusiasm for caring for complex patients.
“I like my team, the vibe and energy in IMCU,” said Dr. Schmidhuber. “We couldn't do it without all the ‘good souls’ on our unit, and I am very appreciative of everyone making this unit run as smoothly as it does!”
“What drew me to this unit was the strong sense of belonging and teamwork,” added Kayla Smith, RN. “Being part of this team feels like being part of a family, and that makes all the difference.”
The wide variety of conditions this department treats provides them with a well-rounded clinical experience. Many emphasize that working alongside their highly trained colleagues is both incredibly satisfying and rewarding.
“When it comes down to it, all of us on the floor during our shift have each other’s backs,” said Nicolas Poynter, RN. “It’s important to be flexible and ready to roll with the punches.”
As someone with a knack for adapting to whatever the day brings, you’ll bring your natural compassion and dependability to the floor.
“A good coworker in the IMCU is someone who brings reliability, empathy and teamwork to every shift,” said Kayla Smith, RN. “Because our patients are complex and the pace can be intense, it’s important to have colleagues you can count on. Communication is key, as is being adaptable and staying calm under pressure. But beyond skills and knowledge, a great coworker genuinely cares not just about the patients, but about the whole team. They help create an environment where everyone feels valued and motivated to provide the best care possible.”
“Someone who is a solid team player, able to keep up with a fast pace and learn new things (plus has a good sense of humor) would be a great fit,” added Desirae Butler, RN.
Discover the possibilities of a career at Renown. The team on T6 is ready to welcome you with open arms.
“IMCU has so much to offer. It’s a place full of learning and growth. Being challenged like we are in the IMCU is essential to becoming a better nurse. Every day pushes you to expand your skills, think critically and adapt quickly. That’s where the real growth happens, and it’s what makes working here so rewarding,” closes Kayla Smith, RN.
