Respiratory Therapist

Respiratory Therapists are the specialists who manage anything that affects how a patient breathes. From the ED patient with a severe asthma attack to the ICU patient on a ventilator for three weeks, from the home COPD patient struggling with their inhaler technique to the neonatal patient with immature lungs — the RT is the clinical professional trained specifically for the pulmonary dimension of the case.

In hospital settings, the work spans the range of respiratory acuity. Floor-based treatments — scheduled nebulizer treatments, incentive spirometry coaching, oxygen management — are part of every shift. But the cases that define the profession are the critical ones: the patient who is tiring out with respiratory failure and needs BiPAP to avoid intubation, the ventilated post-op patient who is ready to wean but not quite meeting the criteria, the COPD exacerbation in the ED that needs immediate bronchodilator response before the decision to admit or escalate.

The difference between a CRT and a more experienced RRT isn't just credential level — it's pattern recognition and decision-making speed under pressure. A seasoned RT walking into a room reads the respiratory pattern, the work of breathing, the accessory muscle use, and the SpO2 together in seconds and forms an impression before opening the chart. That clinical intuition is the product of repetition and deliberate attention to feedback from outcomes.

Beyond critical care, respiratory therapists run pulmonary function labs, provide sleep study support as polysomnographic technologists (with additional certification), manage COPD patients in disease management programs, and support smoking cessation programs. Each of these represents a different kind of contribution — some more technical, some more educational, all requiring the pulmonary foundation that the RT credential provides.

Education:

• Associate of Applied Science in Respiratory Therapy (most common, 2 years)
• Bachelor of Science in Respiratory Therapy (growing preference at academic medical centers)
• CoARC accreditation of the program is required for NBRC exam eligibility

Credentials:

• NBRC Certified Respiratory Therapist (CRT) — TMC exam low cut score
• NBRC Registered Respiratory Therapist (RRT) — TMC high cut score + CSE
• State RT licensure — required in most states
• NBRC specialty credentials: RRT-ACCS (critical care), RRT-NPS (neonatal-pediatric), RRT-SDS (sleep disorders), RRT-PFT (pulmonary function)

Core clinical competencies:

• Oxygen therapy: flow rates, delivery devices, titration to SpO2 targets
• Aerosolized medications: SABA, LABA, SAMA, LAMA, inhaled corticosteroids, mucolytics
• Incentive spirometry and airway clearance techniques
• Non-invasive ventilation: CPAP, BiPAP, high-flow nasal cannula initiation and management
• Invasive ventilation basics: volume control and pressure control modes, alarm limits, circuit management
• ABG interpretation: pH, PCO2, HCO3, acid-base disorders, oxygenation indices
• Airway suctioning: oropharyngeal, nasopharyngeal, endotracheal

Technology platforms:

• Ventilators: Puritan Bennett 980, Maquet Servo-i, Drager Evita
• NIV: Respironics V60, ResMed Lumis
• EHR respiratory modules: Epic Respiratory module, Cerner PowerChart

Respiratory Therapy employment is projected to grow approximately 13% through 2032 — significantly faster than average — driven by aging demographics, chronic lung disease burden, and the lasting pulmonary consequences of COVID-19 on a substantial portion of the population.

COVID-19's effect on this field was direct and visible: RT departments were overwhelmed with ventilator-dependent patients during pandemic surge periods. That experience raised the profile of respiratory therapy within health systems, and many institutions subsequently expanded their RT staff and training programs. It also exposed the workforce's thin margins — when demand doubled, there weren't enough experienced RTs to absorb the volume, which drove the travel RT market to historic premiums.

The respiratory workforce shortage has not fully resolved. ICU-experienced RTs remain difficult to hire in most markets. SNF and long-term acute care (LTAC) facilities, which often have ventilator-dependent populations, struggle to recruit at the salary levels they can support. Home health respiratory therapy is growing as health systems invest in preventing COPD and CHF readmissions through post-discharge support.

For new graduates, the two-year credential path is one of the most efficient in healthcare. Starting wages are above the national median for all workers, the RRT credential is achievable within the first year of employment without additional school, and specialty certifications open progressively higher-paying niches. ICU and neonatal RTs with 5–10 years of experience and advanced credentials are genuinely difficult to replace, giving them meaningful leverage in salary negotiations.

The profession also has natural adjacency to advanced practice. RT-to-PA programs exist at several universities, and some experienced RTs pursue advanced clinical degrees in nursing, PA studies, or respiratory therapy management.

Dear Respiratory Therapy Manager,

I am writing to apply for the Respiratory Therapist position at [Hospital]. I hold my CRT credential from the NBRC and am a licensed RT in [State]. I graduated from the Respiratory Therapy program at [School] in August and I'm preparing to sit for the high cut-score TMC retake and the CSE to pursue my RRT credential this winter.

My clinical rotations included the adult ICU, medical-surgical floors, and a significant amount of time in the pulmonary function lab at [Site]. My strongest clinical preparation is in general floor care — managing treatment schedules for a busy census, troubleshooting oxygen delivery equipment, and performing bedside spirometry. I'm comfortable with non-invasive ventilation initiation and have had supervised experience with CPAP and BiPAP titration for patients in mild respiratory failure.

The rotation experience that clarified my clinical direction was two weeks in the medical ICU. I worked alongside an RRT with 12 years of critical care experience, and the way he read patients — the combined picture of mechanics, gas exchange, and clinical context — was unlike anything I learned in the classroom. I want to develop that clinical reasoning, and I know it takes sustained ICU exposure to build it.

I understand that [Hospital] has a structured orientation program for new RT graduates that includes ICU mentorship. That structure, alongside the RRT credentialing support you offer, makes this exactly the environment I'm looking for.

I'm available for rotating shifts including night differential assignments.

Thank you.

[Your Name], CRT