An issue I found with change from PCA-to-RN status is that the nurse is too hard on herself. You say "so I have hospital experience", and you do, and it is valuable. But, it is completely different when you are the one the PCA is coming to, reporting an abnormal situation that needs to be addressed immediately, and you are trying to get report on your other 4 patients, and a physician is on the phone, and your charge nurse just gave you an admit. It is overwhelming at first, and you think to yourself that you have experience, and know what it is like, and why can't you do this like the super-nurse you have always thought you would be? You need to be gentle with yourself. Realize you are new to this. Like CrazyCatLady says, ask, ask, ask! Stay enthusiastic and idealistic, and do the best you can, but know there are days that will be overwhelming, and that is OK. Your shift will end, someone else will take over the patients, and you will get to clock out and go home (and cry if you need to). Best of Luck!!!