Let me just say, IT GETS BETTER!! I am going on 6 months as a new grad without healtcare experience in a busy ER. We FREQUENTLY hold ICU patients in our ER because we don't have beds available. I'd say this... If you feel overwhelmed, tell your charge nurse. Ask her/him to review your charting/orders to make sure you have done as much as possible in the ER. In our ER we do STAT admission orders (Antibitoics, breathing txs, BP meds if needed, tests, labs, etc). I wouldn't worry too much. You are not expected to get all the admission stuff done! I'd say make sure the pt is stable, chart sedation and basic stuff that shows pt care is being provided. Make sure tests needed are ordered by ward clerk (EKG's, labs, wounds, cultures, influenza swabs, ua, etc). I would verbalize to admitting Doc things that need to be adressed like wound consults, etc. We don't acutally initiate these consults in our ER... Just remember, you are new and learning, and dont be expected to know EVERYTHING. I feel SO MUCH better after 6 months exp and it gets better each shift. I ALWAYS tell my charge if I feel overwhelmed or out of my scope of practice and ask them to review pt charting, nursing notes, and orders to make sure I have what is needed. I CHART THIS TOO. Sometimes you can only do what you can do... I remember going home one night after having an ICU pt and realizing I never had "orders" for the NGT I placed, never charted "sedation scale" (IE Ramsey, etc), BUT, I did an excellent job of charting pt status, vitals, sedation according to protocol, ER and admission orders, etc. I talked to my charge and was praised for such an excellent job. Just remember, you will get better with time! In the meantime, do what you need to protect your license and ask for help when needed! Hope you find the transition gets easier!