I agree and in my hospital, it is mandatory to keep the certification current. If you've been in the ER long enough, a lot of it is second nature, but there are many skills they teach you that, while you wont do them often, are important to know how to do properly as to not further injure your patient. Example: A patient came into the ER after a motorcycle accident where the EMS left the helmet on and secured it to the backboard. Not sure why they didn't take it off on scene as they usually do, but I got to use a skill I never thought I'd use from TNCC almost three years after taking it. Another class I like is ENPC. It includes some PALS info, but it focuses more on the pediatric body's response to various trauma and signs to look out for to try and prevent them from decompensating (is that a word?) because while a peds patient can compensate for blood loss, etc., for longer than an adult, it's very difficult to bring them back when they can no longer keep up.