Things you wish you knew....

#1 if you are in charge of your unit then there are some things you can change.
Big units with hopelessly long med passes, split the med pass up between two halfs of the unit. 7am and 9am or 8am and 10am that way you will have your meds in the patients on time nearly all of the time. Work this out with pharmacy and the DON of course but you can make that change without their input if necessary.
#2 Make your decisions based on patient advocacy, you won't go wrong with that direction and make sure the basis for your decision is documented. (ie patient behavior, patient complaints, family complaints, family behavior etc)
#3 Utilize ancillary staff, nutritionist, social worker, case manager, respiratory therapist, physical therapist....any problems you have are probably their problems too. Send e-mails and hand notes often and always keep copies in your own file that you keep in a locked locker or file case you take home. Occasionally things are misunderstood so you will have the original document to show for clarification.
#4 organize your shift so you will get your work done and charting done, learn to prioritize when something out of the ordinary happens. What meds can be given 2 or 3 hours later and have no problems, what treatments can be delayed also.
#5 an irate patient or family member can be quickly calmed by writing down information and telling them that this issue will be addressed to the charge nurse, DON, medical director, administrator or whom ever they think needs to know about it. Have the shift supervisor also chat with them so they know the issue is being recognized.
These are the big ones I can think of, I worked as a supervisor in a large facility with LTC, sub-acute and dementia for 5 years, I also worked all 9 units as needed. I had 8 years of acute care prior to this so going from 2 patients to 28 or 36 was a big change.
Good Luck!!!