How to Get NIH Stroke Scale Certification

The National Institutes of Health Stroke Scale (NIHSS) is a diagnostic tool designed to assess neurological impairment in acute stroke patients. The tool is also a predictor of stroke outcomes. Specialties Neuro Knowledge


How to Get NIH Stroke Scale Certification

Initially designed for clinical research2, healthcare professionals use the NIH Stroke Scale in hospitals to assess acute stroke patients. The scale can also measure the patient's response to stroke treatments like tissue plasminogen activator (tPA).

Healthcare professionals must undergo specialized training and certification to administer the NIHSS3. Read on to learn how to get the NIH Stroke Scale certification. 

What is the NIH/NIHSS Certification?

The American Stroke Association (ASA), the National Institute of Neurological Disorders and Stroke (NINDS), and the American Academy of Neurology (AAN) created the NIHSS training and certification4. The NIH Stroke Scale certification program trains participants to administer the NIHSS tool correctly. The following is a list of a few healthcare professional groups that need the NIHSS certification.

  • Nurses
  • Nurse Practitioners (APRN)
  • Neurologists
  • Emergency room physicians
  • Clinical researchers
  • Physician Assistants

The certification course has three components. First, the course instructions are at the beginning of the modules. Next are short video demonstrations for the 11 stroke characteristics listed on the NIHSS tool. Finally, the certification portion of the course follows the video demonstrations.

In real-time, the NIHSS assessment takes about 15 minutes, and the healthcare team can perform the test throughout the patient's hospital stay. Frequent testing aims to track patient condition changes from their baseline NIHSS score. Subsequent assessments can measure how the patient is responding to treatment.

A modified version5 of the NIHSS, or the mNIHSS, is available and just as accurate as the complete assessment tool. The mNIHSS includes all items as the current NIHSS except for the visual, limb ataxia, and dysarthria sections. As a result, nurses and other clinicians can perform the mNIHSS in less time than the current NIHSS. 

How to Get NIH/NIHSS Certification

To get certified, you must complete a NIHSS training and certification program and recertify each year. Both in-person and online education options are available.

Get Your NIHSS Certification Online Free

You can get your NIHSS certification for free online. However, your employer may contract with a continuing medical education (CME) vendor for the certificate. If you must find a vendor on your own, there are many options, and some offer free certification.

The NINDS lists two free accredited online programs6. BlueCloud®7 and Apex Innovations8 are online education platforms that offer free NIH Stroke Scale training and certification courses. Both programs are worth 3.0 continuing education (CE) hours. 

The American Heart Association9 (AHA) also offers a free certification exam. However, you must have a membership for this benefit. The cost of an annual membership for AHA starts at $109 for early career professionals and students and goes up to $485 for the professional premium plus membership.

Whether free or paid, online certification program enrollment follows a similar process. First, you create a username and password, then enroll in the course. Once you complete the course, print a few copies of your certificate. The CE provider will store your test results in their database, which will be available when you are ready to take your next certification exam.

Certification Course Modules

The NIHSS certification program includes six tests9; each takes about an hour to complete. Test Groups A, B, C, D, E, and F each contain a cohort of six patients. You can only get certified in one group at a time. If you are attempting NIHSS certification for the first time, your exam will be on Test Group A.

The objective9 of each certification course is to learn the importance of accurately assessing stroke patients with the NIHSS. You'll learn the correct technique for measuring neurological deficits. You'll also learn how to appropriately and consistently assess stroke patients using the scale.

To earn the certification, test takers must complete each exercise, pass the certification portion of the course with a score of 93% or more, and complete the course evaluation. Furthermore, you must complete the training exercises before you move on to the certification part of the exam.

The course modules begin with a short video demonstration of every item on the NIH Stroke Scale. The videos include an investigator who administers the assessment and a stroke patient. After watching each short video, you score the 15 test items. To pass the exam, you must score 90 test items with at least 84 answered correctly.
The 11 sections of the test include the level of consciousness, best gaze, visual, facial palsy, motor arm, motor leg, limb ataxia, sensory, best language, dysarthria, extinction, and inattention. Test item scores range from 0 to 2, 0 to 3, or 0 to 4. The higher the score, the greater the neurological impairment.
The certification process for test groups B-F is the same. The number of times you can take the exam varies by institution. Blue Cloud will allow up to five attempts at NIHSS certification. But the system locks you out after five unsuccessful tries.

How Long Does the Certification Last?

NIHSS certification lasts for one year. But with the initial certification for test Group A, you can recertify with test Group B in six months. After your first recertification with test Group B, you must recertify yearly with the next exam in the series.

Example Test Questions and Answers

In the first video demonstration for the level of consciousness (LOC) item 1b on the NIHSS, the investigator asks‌ the patient, "What is the month?" and "How old are you?". The patient states the correct month and his proper age. Since this question assesses the patient's LOC and the patient answered both questions appropriately, his score is 0. Conversely, if the patient answers both questions incorrectly, his score is 2. 

Original Allnurses Post

"I've completed certification A in about 2 hours and got a certificate for that. It's presented by the National Stroke Association and American Academy of CME. Do I need to complete all certifications from A through I to become NIHSS certified? Or do I need to get this done through AHA?”

You've completed your Test Group A NIHSS certification, valid for one year. Thus, it is unnecessary to take a certification course with AHA. In six months, you can recertify by taking Test Group B with the same CME provider. 

STAFF NOTE: Original Community Post 

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:


Am I doing this right? I've completed certification A in about 2 hours and got a certificate for that. It's presented by National Stroke Association and American Academy of CME. Do I need to complete all certifications from A through I to become NIHSS certified? Or do I need to get this done through AHA?


  1. Schlegel, D., Kolb, S.J., Luciano, J.M., Tovar, J.M., Cucchiara, B.L., Liebeskind, D.S., & Kasner, S.E. (2022, December 5). Utility of the NIH Stroke Scale as a Predictor of Hospital Disposition. Stroke, 34(1), 134–137.
  2. Anderson, A., Klein, J., White, B., Bourgeois, M., Leonard, A., Pacino, A., Hill, J., & Lyden, P. (2020, January 28).  Training and Certifying Users of the National Institutes of Health Stroke Scale. Stroke, 51(3), 990-993.
  3. Zeltzer, L. (2008, August 19). National Institutes of Health Stroke Scale (NIHSS). Stroke Engine.
  4. American Heart Association eLearning. (2020). NIH Stroke Scale - Test Group A.
  5. Lyden, P.D., Lu, M., Levine, S.R., Brott, T.G., Broderick, J., & the NINDS rtPA Stroke Study Group. (2021, June 1). A Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials. Stroke, 32(6), 1310–1317.
  6. Know Stroke. (n.d.). Health Professional Resources. National Institutes of Health National Institute of Neurological Disorders and Stroke.
  7. NIH Stroke Scale. (2021). NIH Stroke Scale.
  8. Know Stroke. (n.d.). Take the NIHSS Training. Apex Innovations.
  9. American Heart Association Lifelong Learning. (2023). NIH Stroke Scale.

Kimberly Madison is a freelance health content writer with over 13 years of experience as a registered nurse.

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Specializes in MICU, SICU, CICU.

Most hospitals require a yearly certification and would expect you to complete Test B next year, C the following year and so on.

The test and certificate is the same on the website you listed or at this one. It is best to stay with one or the other to have the transcript. Save your login and password for next year. I write it on the back of the certificate.

NIH Stroke Scale Certification A - F

Specializes in ICU.

My job uses the one, too, so you're doing it right. We just do one of them each time.

Thank you guys , info was helpful

Good luck!!

I have used the above TraningCampus/BlueCloud site for the last 2 years (Certification A & B). I logged in this year and it will not show me any further versions. I need Certification C for this year but I can't find it anywhere. Has anyone else run into this problem?