All nurses in the United States need Basic Life Support (BLS) certification designed for healthcare providers. This is the baseline requirement for nursing school clinical rotations, hospital employment, and state licensure. Depending on where you work, you may also need advanced certifications like ACLS or PALS on top of BLS.
BLS: The Universal Requirement
BLS for healthcare providers is not the same as the CPR class you might take at a community center. The healthcare provider version covers high-quality CPR for adults, children, and infants, along with skills that standard CPR courses skip entirely: delivering ventilations with professional equipment like bag-valve masks, performing as part of a multi-rescuer team, using an AED, and relieving airway obstructions in all age groups. The course follows the American Heart Association’s 2025 guidelines for CPR and emergency cardiovascular care.
Every hospital system, nursing school, and clinical site requires this certification before you can touch a patient. Nursing students typically need a valid BLS card before starting their first clinical rotation, and most programs won’t let you register for clinical courses without one.
ACLS: Required for Critical Care and Emergency Nurses
Advanced Cardiovascular Life Support (ACLS) goes beyond basic CPR into managing cardiac arrest, stroke, and other life-threatening emergencies. It covers rhythm recognition, emergency medication protocols, and team-based resuscitation leadership. If you work in an emergency department, intensive care unit, operating room, post-anesthesia care unit, or cardiac catheterization lab, your employer will almost certainly require ACLS certification.
Some hospitals require ACLS for all nurses on medical-surgical floors as well, though this varies by facility. If you’re a new grad hired into a critical care unit, many hospitals give you a window of 90 days to six months to complete ACLS after your start date. Others expect you to have it before your first shift. Check with your specific employer, because policies differ significantly.
PALS: Required for Pediatric Settings
Pediatric Advanced Life Support (PALS) certification is the pediatric counterpart to ACLS. It teaches a systematic approach to assessing, recognizing, and stabilizing infants and children in emergencies. Nurses who work in pediatric emergency departments, pediatric ICUs, neonatal ICUs, labor and delivery units, and pediatric surgery typically need PALS. Some general emergency departments also require it since children show up in any ER.
A related but less intensive course called PEARS (Pediatric Emergency Assessment, Recognition, and Stabilization) exists for nurses who encounter pediatric patients less frequently, such as those working in urgent care clinics or school health settings. PEARS is not a substitute for PALS in units that specifically require it.
AHA vs. Red Cross: Which Provider to Choose
The American Heart Association has been the dominant certification provider for decades, and many hospitals and nursing schools only accept AHA cards. The American Red Cross launched equivalent ACLS and PALS courses in 2019, and the U.S. Military Health System was the first major organization to formally adopt them after confirming the curricula were equivalent. Both organizations base their courses on the same international resuscitation science guidelines, so the content and practice standards are the same.
The catch: not every employer accepts both. Thousands of hospitals and clinics recognize Red Cross certifications, but some medical centers, nursing schools, and community colleges still have policies that only accept AHA cards. Before you sign up for any course, confirm with your employer or school which provider they accept. Paying for the wrong one means paying twice.
Online Courses Still Require Hands-On Testing
You can complete the didactic portion of BLS, ACLS, and PALS online, but a fully online certificate with no skills assessment is not valid for nursing employment. Both the AHA and Red Cross require an in-person hands-on session after you finish the online coursework. During this session, an instructor watches you perform CPR on a manikin, demonstrate proper ventilation technique, and use an AED. Without that skills check-off, the certificate won’t be accepted by any hospital or nursing program.
Be cautious of third-party websites advertising “100% online” CPR certification for healthcare providers. These are not recognized by hospitals, state boards of nursing, or accrediting bodies.
Renewal Timeline
BLS, ACLS, and PALS certifications all expire after two years. Renewal courses are shorter than the original certification class since they assume you already have the foundational knowledge. Most employers expect you to renew before your card expires, not after. Letting your certification lapse can pull you off the schedule until you recertify, so many nurses set a reminder a few months before expiration.
Some hospital systems handle renewals in-house, running BLS and ACLS classes on-site for their staff. Others expect you to find and pay for your own renewal course. If your employer offers it, take advantage of it. It’s one less thing to coordinate on your own time.
What You Need at Each Career Stage
- Nursing school: BLS for healthcare providers, obtained before clinical rotations begin.
- New graduate on a general floor: BLS. Some employers prefer or require ACLS.
- Emergency department or ICU: BLS plus ACLS. PALS may also be required depending on the patient population.
- Pediatric units: BLS plus PALS. Some facilities also require ACLS.
- Operating room or PACU: BLS plus ACLS at minimum.
- Outpatient or clinic settings: BLS is typically sufficient, though some clinics require ACLS depending on the procedures performed.
The simplest approach: get your BLS through a provider your school or employer accepts, then add ACLS or PALS based on the unit you’re hired into. Your job offer letter or onboarding paperwork will list exactly which certifications are required and by what date.