I recently completed my 12 week pregrad placement in the ER before graduating from my PN program so I can probably offer you some sound advice based on my experience! My list is not entirely skill related, but these are some of the big lessons I took away from my 450 hours in the ER
1) First and foremost, make a point of getting around the unit to offer a helping hand where needed whenever possible. Nurses will remember you (especially during pregrad when the floor isn't always crawling with other students) and if they see your desire to learn they will seek you out for every opportunity possible.
2) Do not be afraid to ask questions, and don't feel limited to only asking your preceptor. The ER is an excellent unit to work on if you want to experience working as a part of the interprofessional team. There are a ton of doctors, residents, RNs, RPNs, social workers, OT/PT, RT, dietitians etc., and we can all stand to learn a little bit about what the other does in terms of a client's plan of care. Ask ask ask.
3) Practice giving a thorough but concise report, as even seasoned nurses can find report to be a nerve-wracking experience (based on some posts I've read on AN). A large majority of patients in the hospital have come through the ER before being admitted to their respective floors, and as the one who has provided their care, the nurses on the other floors will be looking to you for report. If time permits, explain you are a student and ask for feedback on your report after you have given it. Every bit helps.
4) Don't be disappointed if the ER is not always as action packed as you thought. Don't get me wrong, there will be crazy days and you will see and learn tons, but be prepared for the other side of things as well. A lot of the people coming to the ER present with influenza, gastro (WAY more BM than I expected), minor ailments, cuts and scrapes, asthma/COPD, mental health clients, palliative from long-term care, etc., and as an RPN/PN student you will be providing care for these more stable patients.
5) IV therapy - IVs are everywhere in the ER, know your solutions, your calculations, and what your facility will actually allow you to do as a student. It's a great place to get a ton of practice with tasks things like priming lines, disconnects, bag changes, etc.
6) As I mentioned before, be prepared to work with A LOT of patients experiencing asthma/COPD exacerbations. Very common in the ER and it would be beneficial to brush up on your oxygen therapy and nebulizer treatments.
7) Read up on the Canadian Triage and Acuity Scale (CTAS). This is what it all comes down to in the ER and it will show initiative if you already have some background knowledge when your preceptor brings it up.
8 ) Lab values. Lucky for us, most times the parameters are included with the results (at least that has been my experience) but it's good to refresh your memory about what they all mean. I kept a lab diagnostic book in my bag and it was a great resource.
9) IM injections. Because of all those cuts and scrapes I mentioned the Tetanus/Diptheria shot is given pretty frequently.
10) Catheterization is a pretty common procedure in the ER. I had never inserted one in anything other than a mannequin before being in the ER but felt pretty comfortable with it by graduation.
11) There is not a lot of focus on mental health in the PN program in comparison with how many people are suffering from mental health issues in the real world. It is a shame. Brush up on the Mental Health Act and the different forms that are in place under the Act (involuntary admission, etc.). Not only will you (probably) see a wide variety of mental health issues but also individuals suffering from a downright failure to thrive. In the early days of my placement I provided care for an elderly gentlemen who arrived in the ER wearing clothes covered in mold, severely malnourished and unkempt, using a broken shovel as a cane, living alone with severe dementia... It was eye opening and certainly not the last client I cared for who was living in these conditions. It broke my heart. The ER can be an emotional environment and can cause even the most composed and experienced nurses to come unravelled at times.
Sorry this was so long, I can't say enough positive things about the experience I had! I could go on and on! I hope you get to learn and experience as much as I did