As a brand new nurse myself, here are some tidbits of advice:
* You will make mistakes - everyone does! So don't sweat it.
* You won't be expected to know everything right off the bat - nursing school prepares us with a baseline knowledge of nursing, but you don't learn how to BE a nurse until you start working. With that said, ASK QUESTIONS! No question is a stupid question. As a new grad, you should have a lot of questions - I fear for those who don't. I'm a new grad and I always have questions. Even seasoned nurses with 4+ years of experience still ask questions. Also, ask the doctor questions! Usually they are receptive to your questions (I work night shift, so when I call them at 0330 I try to get to the point when talking to them instead of asking a bunch of questions, unless it may impact patient safety or something)
* Calling the doc IS scary at first and will be scary for awhile. Just remember SBAR and always have your patient's chart in front of you. Thankfully all of the doctors I have worked with so far have been very pleasant, but some can be rude. Don't take it personally. Just remember that you are trying to do what is best for your patient and it is their job to be on call AND they are getting paid a lot of money to do so. If you are ever unsure if you should call the doc (or who to call), ask another nurse! If your patient looks bad, you can always call rapid response, too. They can give you a second/third/fourth/etc opinion (because sometimes docs don't always answer their pagers!)
* If you are EVER unsure about ANYTHING, ask! Or look it up. I carry an IV drug book, regular drug book and another book called The Manual of Critical Care Nursing with me. I will still look things up when I get home, or at work when I have some downtime.
* If another nurse or doctor is going to do a procedure, ask if you can watch or better yet, ask if you can do it yourself! (within your scope, of course...you obviously can't do a chest tube insertion but you can assist with one!
* Sometimes you won't be able to chart until much later in your shift - hopefully not at the end. You will start to become good at remembering things, but I always keep a piece of paper in my pocket along with my "brain." as I do things, I write it down AND the time that it happened. You might not be able to chart that 400cc's of urine you dumped at 0100 right away. Whenever you have to call the doctor about anything, always note the time when you called them, what it was for and what you were told. Some examples:
Lab calls you to report a critical lab value: Ammonia level of 90. Pt has end-stage liver disease and this to be expected; however, you still need to report it. "Called Dr. ____ at 0600 to report critical ammonia value of 90. No orders received." "Called Dr. ____ at 2100 about holding Lopressor because pt HR is 57. Dr. ____ said that was okay."
* I work night shift, and our labs usually come back between 0530-0600. Unless it is absolutely critical and the patient is in distress (such as a troponin of 2.59, chest pain and ST-segment elevation), we usually wait until EVERYONE'S labs come back, ask who needs to talk to the doc and when they call, pass the phone around, that way the doctor isn't receiving 5 different pages. Doctors really like this. Of course that isn't always possible. But just a thought!
* Try to leave work at work - meaning when you come home, just don't worry about it anymore. I still have problems with this and have woken up from deep sleep in a panic because I forgot to chart the patient's response to some PO Benadryl I gave at 0630
Since it was PO technically the response shouldn't be documented until 0730, but I was still freaking out! Just over little things like that. I have asked my coworkers and I have been told they have all had similar things happen to them.