Everything Nurses Need to Know About ACLS, BLS & PALS Certifications

As nurses, education doesn’t end after passing the NCLEX. Nurses are required by law to have the basic skills needed to save a life, whether they work in a hospice setting or an intensive care unit they will need additional certifications required for employment. The most common of these certifications include BLS, ACLS, PALS. 

FAQs About BLS, ACLS and PALS Certifications

• Who is required to have BLS, ACLS and PALS certifications? 

  • The Basic Life Support (BLS) certification is required for all registered nurses. Advanced Cardiovascular Life Support (ACLS) is required for RNs working in the ICU or with adults. Pediatric Advanced Life Support (PALS) is required for RNs working with pediatric patients.

• What is the difference between BLS and ACLS? 

  • Basic Life Support (BLS) is the generic term for any form of CPR and is required for all registered nurses. Advanced Cardiac Life Support (ACLS) is primarily required for RNs who work in a hospital setting and care for critically ill adults. 

• Does ACLS cover BLS?

  • No ACLS does not cover BLS, the two certifications must be obtained separately. Regarding the ACLS, you must have a BLS certification in order to take the course.

• Do hospitals accept online BLS certification?

  • Most hospitals require registered nurses to obtain their BLS certification through an American Heart Association (AHA) accredited course. The AHA does not currently offer or endorse any online BLS certification courses. Therefore, if you plan to work in a healthcare setting, especially a hospital, you should not take an online BLS course. Otherwise, you will likely be wasting your time and money because your employer likely will not accept an online certification.

When Should You Get BLS, ACLS and PALS Certifications?  

BLS, PALS, and ACLS are requirements for nurses and do not have to be obtained prior to applying for a job. Healthcare companies offer these certifications to employees while employed. 

• Most job offers will indicate that individuals must obtain their BLS prior to starting on the unit and PALS and/or ACLS must be completed within 3-6 months of employment. Graduate nurses may have some leeway with this. 
• Per diem nurses will be expected to already have these certifications. Nurses will work with unit and hospital educators to set up times to complete these certification courses.

While obtaining these certifications are imperative for all nurses, they do not necessarily make you more marketable by having prior to applying especially if you are a new nurse. BLS, PALS, and ACLS are considered essential for nursing jobs and something hospitals will offer free of charge to their employees.

For this reason, it is not recommended to obtain them prior to starting a new position because then it is on you to pay upfront. If you want to earn these certifications prior to starting a new job, be wary and do your research and be prepared to pay! Most employers will not compensate employees for money spent out of pocket for these certifications.

What is the Basic Life Support (BLS) Certification?

The American Heart Association (AHA) offers two different pathways for BLS certification – one for the trained healthcare professional and the other for the layperson. Only nursing students and nurses qualify for the healthcare professionals’ course. During this course, individuals will learn the following:

• CPR for adults, children, and infants
• AHA Chain of Survival
• Use of an AED
• Effective ventilations using a barrier device
• Two-person CPR
• Foreign-body airway obstruction (choking) removal for adults and infants

>> Explore BLS Certification Review Materials*

Changes to the BLS 

In 2015, the American Heart Association changed the recommendations for more effective life-saving care. After the AHA made the recommendations, the Red Cross also adapted the new guidelines.

Previously, the guidelines were to follow the ABCs (Airway, Breathing, Compressions) while the new guidelines recommend CAB (Compressions, Airway, Breathing) instead.  The emphasis is being placed on early initiation of chest compressions without delay. Research has shown that there are improved outcomes when the focus is on chest compressions immediately after cardiac arrest and not immediate airway management.

Furthermore, with the increase in technology, focus has been placed on utilizing the speakerphone function while talking to emergency medical services instead of leaving the individual that is in distress. If a cell phone is not available, rescuers are advised to spend two minutes giving strictly chest compressions prior to leaving to call for assistance.

The importance of high-quality chest compressions was emphasized with a focus on chest compressions being delivered at a rate of 100 to 120 per minute without removing the hands from the chest. Compressions at a rate higher than 120 per minute may not allow for cardiac refill and reduce overall perfusion. AEDs should be used as soon as possible and then chest compressions should be immediately resumed.

Another major change to the BLS guidelines is pulse checks. New recommendations state that pulse checks should not be for more than 10 seconds while in the past pulse checks were 30 seconds. If a pulse is absent or the rescuer is unsure, chest compressions should be started immediately.

What is the Advanced Cardiovascular Life Support (ACLS) Certification? 

ACLS is specially designed for professional healthcare providers who take care of critically-ill adults and focuses on individuals that work in the hospital setting. Healthcare professionals that work in the ER or ICU will be required to have this certification. Medical-surgical nurses may not be required but highly encouraged to take an ACLS course. Recommendation: if the course is offered and recommended – take it!

>> Explore ACLS Certification Review Materials*

According to the AHA website, healthcare professionals that take ACLS will learn the following:

• Review of BLS skills
• Recognition and early management of respiratory and cardiac arrest
• Recognition and early management of peri-arrest conditions such as symptomatic bradycardia
• Airway management including intubation
• Related pharmacology
• Management of ACS and stroke
• Effective communication as a member and leader of a resuscitation team

What is the Pediatric Advanced Life Support (PALS) Certification?

PALS is a specialty certification that specifically teaches medical professionals life-saving care to infants and children. PALS is not designed for the critically ill neonate and is not used in the NICU setting.  It is designed to teach rescuers how to properly assess patients, provide advanced interventions, and utilizing scenarios while applying critical thinking skills.

>> Explore PALS Certification Review Materials*

Skills learned at PALS include:

• Review of child and infant CPR
• Review of child AED
• Recognition of patients who do and do not require immediate intervention
• Recognition of cardiopulmonary arrest early and application of CPR within 10 seconds
• Understand how to properly apply team dynamics
• Differentiation between respiratory distress and failure
• Early interventions for respiratory distress and failure
• Differentiation between compensated and decompensated (hypotensive) shock
• Early interventions for the treatment of shock
• Differentiation between unstable and stable patients with arrhythmias
• Clinical characteristics of instability in patients with arrhythmias
• Effective communication as a member and leader of a resuscitation team

While PALS and ACLS do cover BLS information, you must have a BLS certification in order to take the course. Some healthcare companies will offer the BLS certification prior to the advanced class but individuals should not assume this to always be the case. It is important to discuss this with hospital educators. Individuals that take the course through the AHA or Red Cross are required to already have BLS as a prerequisite to ACLS and PALS.

How to Renew BLS, ACLS, and PALS Certifications

Each of the certifications are valid for two years.  

• Initial PALS and ACLS certifications are two-day courses that include a written and a practical exam. 
• Recertification is completed in a condensed eight-hour course. 
• If your certification has lapsed, you will be required to take the initial course. It is important to mention that if your certification expires, you will not be able to work on the unit. 
• Most hospitals do not have a grace period, and the healthcare professional could be suspended if their certifications expire. 
• Renewing certifications can be done through your employer, American Heart Association and/or American Red Cross. If done through an employer, everything is set up and paid for by the healthcare organization. If you decide to renew on your own, you will have to find a facility that you can go to in order to demonstrate the skills aspect. Furthermore, if you decide to renew them independently, you will have to pay out of pocket.

What to Expect on the Certification Exams

Written exams are 25 questions for BLS and 50 questions for ACLS and PALS. The hands-on includes a mega-code that includes real-life scenarios related to choking, cardiac arrest, stroke, and respiratory arrest. Individuals will also have to show highly effective chest compressions as well as rescue breathing.

Why Obtaining Certifications From an Accredited Course Matters

Currently, there are two major certifying organizations for basic and advanced life support that are accepted by hospitals and other healthcare organizations. The American Heart Association (AHA) and American Red Cross (ARC). The AHA is a research-based organization and encourages the learning of CPR through its research. The American Red Cross adheres to AHA guidelines when designing its training materials and developing its courses.

In 2019, the American Red Cross introduced a new learning platform and curriculum for its BLS, PALS, and ACLS courses. These are specifically designed for healthcare professionals in partnership with HealthStream. HealthStream, founded in 1990, is an online company that partners with healthcare organizations for workforce development, provider enrollment, training and learning management, managing online simulation-based education programs, and talent management.

How to Pay for Certifications as a Nurse

Most employers will pay for their employees if it is relevant to their occupation. To find out more information contact your unit educator to discuss which certifications are most relevant to your position.

If you are looking to obtain or renew these certifications independently, first consult the AHA website to find out which certifications you are eligible for. On the AHA website, there is the ability to search for in-person and blended learning classes based off of your home location. More remote areas of the country will have limited opportunities and individuals may be directed to their local hospital.

How much does certification cost? 

Cost is determined by the location and additional fees that must be paid to the hospital and/or instructor. 

• Blended learning for BLS costs roughly $80-90 
• PALS and ACLS is between $100-200 and are strictly in the classroom. 

Individuals are also required to purchase the training manual for the course which can be up to $50 depending on the certification. The manual can be purchased as a hard copy or e-book and must be brought to the training course. Without it, individuals will be turned away from the course.

Are Certifications Required to Work as a Nurse?

BLS is a basic requirement for all nurses and you cannot work as a nurse without it. To find additional information regarding basic and advanced life support, reach out to your employer or contact the AHA and Red Cross website.

It is important to obtain certification through the AHA or Red Cross if not obtaining through you employer. There are independent organizations that offer these certifications but not all are accepted by healthcare organizations. Yes, the courses will teach you everything that is important to the certification but may still not be accepted. Reach out to your employer prior to signing up for a course to determine the best course of action. The AHA and Red Cross offer very similar courses that equivalent in length, difficulty, content, and cost, but some healthcare organizations prefer one over the other.

Ultimately, no matter which certifications you decide to pursue, consider the time and expense a smart investment into your career. Not only will they make you a stronger, more knowledgeable nursing professional, but it could help you save a life.

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