Welcome to this field, I started working on a skilled nursing unit right out of school too. I am still working there. The other nurses have pretty much said it all. Teamwork, teamwork, teamwork. I cannot stress that enough either. Let me give you some advice that has helped me. Some was passed on to me from other nurses, the rest I figured out on my own.
1. Paperwork is a pain, but it is a necessary evil. Not documented, not done. It's as simple as that. My biggest problem is still making time to chart! I can do the work, it's the time you spend writing that takes up your time. The best time to open your charts I have found is after you give your am meds. That way, if you have a prn or something like that you can just chart it after you did it since your chart is already open. Trust me it is easier than trying to remember everything you did right before you leave!
2.When in doubt, ask. You will quickly learn which nurses you can turn to. Unfortunately, not all nurses remember what it was like to be a new grad.
3.Assessment is the one skill you absolutely must develop. Again,look at 2. After report I always start the day by assessing and chatting a little with my patients. That way I know if there are any new problems, needs, or prn meds to give with my morning meds. Make sure you check your vital signs, sometimes your CNA may forget to report something abnormal. It happens even with the best of them!
4.Medication administration is also important. Do not ever give anything unless you know what it is. New drugs come out everyday. Check your med books or call pharmacy if you must. I have seen scary things happen when nurses have simply followed doctor's orders regarding medications. Follow your instincts if something does not feel right.It is also a good idea to write down what your vital signs are in the morning, that way you know whether to give or hold BP medicines and such.
5.Doctors are human too and they make mistakes too. Don't be afraid to question an order you do not understand. It is your license on the line regardless of their mistake.
6.Dressing changes won't seem like such a chore if you set a time to do them all, like after charting in the morning. You may even do them while doing your assessment or after meds. You will find you have a little bit more time in the afternoon if you do that in the morning or vice versa.
7.Above all, you are caring for a special group of people. It can be frustrating at times, but remember, a kind word more often than not will soothe the most bitter soul. Don't take it personally, keep in mind these people are sick, that is why they act that way. If you lived to be 90 wouldn't you want to be left alone too?
8.Objectiveness is one thing I see a lot of nurses struggle with. Remember this is America and people come from all over. You may not agree with their cultural,or religious practices but they have that right. It is not up to you to change it or accept it, but it is your job to respect it.
9.Keep in mind your patients form a part of a family. Include them in their care. They need that too.
10.Above all have fun with your patients. You will learn so much from them. If you have the time, (big if, but it could happen), listen to their stories. They are our country's living history.