I've been an RN for almost 2 years now. I was the most insecure nurse you'd ever meet at first (sometimes still am!), so here is my advice.
1. Trust your assessment. If family is in the room, ask them to step out for a moment so that you don't feel the need to hurry. Assess your patient, head to toe. Ask them questions. Tell them the plan for the shift (if you know). ex. "Today, will will help you wash at the sink, physical therapy will see you, and you have a scheduled MRI." That way, when the time comes for that MRI, they aren't asking you why the heck they are going!
2. IF you have downtime, even for 5 minutes, find another nurse to see if he/she has anything interesting going on with their patients, ex. inserting a foley, NG tube, starting a tube feed, etc.
3. When calling an MD, have information readily available. I always grab the bedside chart for most recent vitals, previous nurse's notes, their I/O sheet, and their chart. That way, the doctor isn't on hold while you are running to find info. They appreciate this and it helps you to gather your thoughts.
4. Find a nurse that you can trust with anything. When you are feeling overwhelmed and maybe insecure, talk with that one person. I still go to one particular nurse for ANYTHING and she loves that I trust her and she has helped me a great deal over the past 2 years.
5. Don't be afraid to ask questions. I still ask a ton of questions, and I find that some questions that I ask, even seasoned nurses do not know...so we we look up the info together.
6. When receiving report, have a system that is individual to you and use it every time. For example, I take report with a black pen and I highlight in pink things that need to be done first. Anything that happens on my shift that is new, (new orders, changes in physical assessment, etc) I write in red so that when I give report, I know this is a change and can pass it along.
7. Something that I started doing when I was brand new was having a space on my report sheet called "my assessment." and I find this EXTREMELY helpful. I have my report sheet in chart form, so I have the basic info first. Name, MD, hosptial day since admission, diagnosis, Past medial history, allergies, IV fluids, PCA settings, Diet/Activity, VS, I/O, Accu checks, labwork. Then, I have a box for "report" where I write down info that the previous nurse gives me, and the next box is entitled "My assessment." After leaving a pt's room, I dont always have time to chart, so I jot down my assessment on my repor sheet..i only write things that are abnormal so that when I chart, i know everything else was normal. for example i jot down, crackles at left base, abd inc with steris, pain 8/10 in LLQ and i will write med. with 2 perc at 2130. That makes charting so much easier later. Also remember, that if your facility charts by exception, then CHART BY EXCEPTION! You are taught to write a full note in school, but charting by exception will save loads of time, especially when you still have paper charting. They made it that way for a reason. That doesn't mean that you didn't do a full assessment. If you check off respiratory, that means that you assessed respiratory and it was within normal limits.
8. Finally, prioritizing is key but it TAKES TIME! I remember wanting to complete as many tasks as possible at first. Constantly running in and out of rooms wastes time. Before you start running off your behind, think ahead. Say to yourself "I have to give room 311 meds at 9. When I go in, I will take all the supplies for the 11 pm dressing change." That will save time later.
My biggest advice, though, to a new nurse is this. If you have to go to the bathroom, GO! If you are thirsty and parched, get a drink! Take care of yourself. You don't want to hurry through administering medications because you can't hold your urine for another second...it is dangerous for you and for the patient. Take those 2 minutes for yourself. Even when I am so busy that I can't stop for a second, I take the time to pee....the 2 seconds away from the nursing world is needed to just stop, relax, and relieve yourself!!!!!