Time Management Troubles

[Biology2Nursing, RN]

So the dilemma I have is that I see that Nursing is actually NOT Nursing School AT ALL. I knew that being a licensed RN would be different but this is insane. There is both good and bad to Nursing not being like Nursing School. I am happy with the independence, autonomy and responsibility and being present but my main problem is trying to time manage my new work load. In school clinicals, we are only to manage one or two patients at a time and now in my first job, outpatient hemodialysis I am responsible for 9 patients each shift. So for me that is 9 pre assessments and 9 post assessments, medications for 9, 30 min vital checks for 9, problems to troubleshoot and all of the catheter patients are mine to initiate and terminate treatment as only the RN can put them on and off the machine. PCT's handle most fistula/graft patients. Managing my PCT's and their workloads gets out of hand as well. I feel like I literally do not have time to breathe some days. Some dialysis patients blood pressure base lines are extremely high yet they remain asymptomatic. When I won't discharge a patient with a diastolic over 90, the patient is annoyed at me saying things such as "you new nurses are killing me, my BP is always high, just let me go!" In this situations, I try to reassure them that it is for their safety. I document that they are asymptomatic/ deny headache and even get them to fill out AMA. These patients who have been on dialysis a long time think that they run the show and want to try to tell me how to do my job. I know that patient satisfaction is important but It is still my priority to keep them safe. If they go home and have a stroke from a high BP, I got in trouble. NOT THEM, NOT THE TECH. I know that nobody is on their best behavior if they are not well but I feel that dialysis patients are extremely difficult. I am doing the best I can. The first year as an RN is the last year of Nursing School.