Registered Respiratory Therapist

Respiratory Therapists are the specialists called when breathing stops being automatic. In the ICU, they manage ventilators — the machines that breathe for patients who cannot breathe for themselves — with a combination of physiological knowledge, mechanical skill, and clinical judgment about when a patient is ready to breathe without the machine again. That weaning process — knowing when to reduce support, what to watch for, and when to call the physician — is one of the most consequential clinical skills in critical care.

The respiratory therapist's day in a critical care-heavy hospital spans the range of pulmonary medicine. They draw arterial blood gases from radial or femoral arteries, analyze pH, PCO2, and oxygenation, and use those numbers to adjust ventilator settings. They manage bronchospasm in the ED with back-to-back nebulizer treatments and help stabilize the pediatric patient in status asthmaticus. They respond to rapid response calls for patients whose oxygen saturation is dropping and decide whether non-invasive ventilation will work or whether the patient needs intubation.

In the neonatal ICU, respiratory therapy is even more technically demanding. Premature lungs are fragile, and the margin for error in ventilating a 24-week neonate is far smaller than in an adult. Neonatal RRTs manage high-frequency oscillatory ventilators, surfactant administration, and the transition to non-invasive support as the infant's lungs mature.

Outside the ICU, respiratory therapists run pulmonary function labs — administering spirometry, DLCO, plethysmography, and bronchoprovocation tests that diagnose asthma, COPD, and interstitial lung disease. They lead pulmonary rehabilitation programs for COPD patients, teaching breathing techniques, exercise conditioning, and disease self-management. Home equipment programs assign RRTs to educate patients on CPAP, BiPAP, and home oxygen equipment.

Education:

• Associate degree in Respiratory Therapy from a CoARC-accredited program (2 years) — most common entry path
• Bachelor of Science in Respiratory Therapy — preferred for leadership, education, and research roles
• CoARC-accredited programs include both general and entry-level master's tracks

Credentials and licensure:

• NBRC Therapist Multiple-Choice (TMC) exam — required for CRT (low cut score) or RRT eligibility (high cut score)
• NBRC Clinical Simulation Exam (CSE) — required for RRT designation
• State RT license — required in most states
• NBRC specialty credentials: RRT-ACCS (Adult Critical Care Specialist), RRT-NPS (Neonatal-Pediatric Specialist), RRT-SDS (Sleep Disorders Specialist), RRT-PFT (Pulmonary Function)

Clinical competencies:

• Mechanical ventilation: volume control, pressure control, PRVC, APRV, HFOV modes; alarm management; weaning protocols
• Non-invasive ventilation: CPAP, BiPAP, high-flow nasal cannula
• Airway management: bag-mask ventilation, assisting intubation, tracheostomy care, suctioning
• Aerosolized medication administration: MDI, SVN, DPI technique education
• Pulmonary function testing: spirometry, DLCO, plethysmography, 6-minute walk test
• ABG analysis and hemoximetry

Equipment platforms:

• Ventilators: Maquet Servo-i/u, Puritan Bennett 980/840, Drager Evita
• Non-invasive: Respironics V60, HAMILTON-C6, ResMed Stellar
• Pulmonary function: ndd EasyOne, Vyaire SensorMedics

The BLS projects respiratory therapy jobs to grow 13% through 2032 — well above the average for all occupations — driven by the aging population and the long-term consequences of COVID-19 on pulmonary health. Long COVID has created a population of patients with persistent pulmonary symptoms requiring ongoing evaluation and management, and the cohort of patients with COVID-related respiratory damage requiring ongoing pulmonary follow-up will sustain demand for years.

The workforce picture within respiratory therapy has an important divide. General respiratory therapist positions in step-down units and outpatient settings are relatively well-staffed in many markets. ICU and neonatal respiratory therapy positions — requiring RRT credential, advanced clinical competency, and specialty training — are persistently difficult to fill. Facilities pay premiums for RRT-ACCS and RRT-NPS credentialed practitioners, and ICU-capable RRTs have significant leverage in the job market.

ECMO-trained RRTs are among the most sought-after professionals in all of intensive care nursing and therapy. As ECMO use has expanded from cardiac surgery to acute respiratory failure and septic shock, more centers are building ECMO programs that require 24/7 trained specialists. ECMO center certification from ELSO is a premium that not many RRTs hold.

Telehealth is opening new practice areas. Remote COPD management programs — which include telehealth follow-up, inhaler technique assessment via video, and remote pulmonary function monitoring — are employing RRTs in roles that didn't exist five years ago. Home health agencies with respiratory focus are growing, particularly as COPD readmission penalties push health systems to invest in post-discharge pulmonary management.

The two-year program-to-credential path remains one of the most compelling in allied health — strong job security, meaningful clinical work, ICU access that many longer-training programs don't provide.

Dear Respiratory Therapy Manager,

I am applying for the Registered Respiratory Therapist position at [Hospital]. I hold my RRT credential from the NBRC, passed the Clinical Simulation Exam in December, and hold active state licensure in [State]. I completed my Associate of Applied Science in Respiratory Therapy at [School] in August.

My clinical rotations covered a wide range of ICU settings — medical ICU, surgical ICU, and cardiac ICU at [Clinical Site] — as well as a significant amount of time in the emergency department and on the general floors. The rotation I found most formative was a four-week assignment in the MICU where I managed ventilated patients under close preceptor supervision. I left that rotation comfortable with ventilator waveform analysis, recognizing patient-ventilator dyssynchrony, and the mechanics of a spontaneous breathing trial protocol.

I am specifically applying to [Hospital] because of the neonatal critical care program. Neonatal respiratory therapy is the area I want to build toward, and I understand your NICU has an active RRT-NPS training pathway for motivated new graduates.

I've been studying for the RRT-NPS exam alongside my current clinical work and plan to sit for it within 18 months. I'm available for rotating shifts including nights and weekends and can begin within two weeks.

Thank you for the opportunity.

[Your Name], RRT