Quite a few challenges...but all normal and manageable!
-"The ways we do things..."
If you have never worked in a hospital before (aside from clinical), it can be quite an adjustment orienting to the logistics of the unit. For example, knowing where supplies are stocked, using the equipment (from IV poles to the phones and fax), charting and locating other documents (protocol forms, short sheets for meds, teaching articles), who does what (dietary staff, respiratory, attendants, transport), where everything is located (lab, pharmacy, central supply, morgue), how to put in orders if you don't have a secretary, what to do if you forget to clock in/out, the codes to the supply rooms, etc. The list could go on. These are all important things to know that you don't really think about until you need to...and it slows you down big time! A few ways to overcome it include getting a good tour of your unit and facility before you start, spending time in the stock rooms when you have time so you know where to find something fast when your in a pinch, and keep a little notebook to jot down little reminders when you need to...just a few suggestions.
-"Policies & Procedures, Protocols, Core Measures and Standing Orders" You learned all about restraints, hyper/hypoglycemia, heparin, insulin, infection control, etc. in nursing school right? Well, now you have to learn specifically how your facility wants you to handle things. Know your P&P, and know where to find all this information. It's your lifeline. Chances are, anything you can do as a nurse has a policy or standard that you must meet and the hospital will not back you up if you fail to follow it.
-"Assertiveness" another poster already touched on this a bit so I will keep my little stent about it breif. Learn it. Don't be agressive, but learn how to hold your ground when you speak to doctors, family members, and other staff. You don't know everything, but you ARE competent...so don't let others treat you as anything less.
-"Who do I call?" The answer in nursing school is always the physician, right? But which one...the admitting doc, or one of the numerous specialist, infectious disease doc, the surgeon...do i page him, call his office, his cell...what if he's on call...what if he doesn't return my page and its an emergency??? Make sure you get to know the docs in your hospital, what their specialties are, and when to call who...I'm still working on this myself.
-"Can you help me/help my patient..." Asking for help and delegating duties. Understanding what your scope of practice is was hard enough to understand at times
, but you must also be awar of what your co-workers job descriptions are and their limitations. Ultimately, you are responsible for the care they provide if they fall under your license (like UAP...unlicensed assistive personnel). It can also be uncomfortable to move from the subordinate role of nursing student into a more leadership focused role as a nurse, who directs the patient care for the day. Be kind to your assistive staff and don't be afraid to ask for help. Help them as much as they help you.
That's all I can think of for the moment, I am in orientation myself and studying for the NCLEX. My brain is crammed right now.
Your best asset is a good preceptor. They are invaluable. Don't be afraid to ask questions and understand that you won't always know what to do and you will make some mistakes.