All Medical Careers

1. Role Overview & Clinical Scope of Practice

Whenever a Code Blue, trauma resuscitation, or acute respiratory distress call sounds in a hospital, the Respiratory Therapist (RT) is at the head of the bed managing the patient’s airway and oxygenation. Working closely with intensivists, pulmonologists, neonatologists, and emergency physicians, Respiratory Therapists evaluate and treat patients across every age group—from micro-premature infants in the Neonatal ICU (NICU) whose lungs lack surfactant to critically ill adults in the Medical/Surgical ICU.

In intensive care units, RTs initiate, titrate, and wean invasive mechanical ventilation and non-invasive positive pressure ventilation (BiPAP/CPAP) based on arterial blood gas (ABG) acid-base interpretation and lung mechanics. They assist with or perform endotracheal intubations, manage tracheostomies, administer aerosolized bronchodilators and mucolytics, and perform bronchoscopies.

In outpatient diagnostic settings, RTs conduct comprehensive Pulmonary Function Testing (PFTs/spirometry), cardiopulmonary stress tests, and asthma/COPD pulmonary rehabilitation.

2. Core Clinical & Technical Responsibilities

In daily clinical practice, a Respiratory Therapist performs the following core responsibilities:

• Initiate, monitor, troubleshoot, and wean invasive mechanical ventilators and non-invasive BiPAP/CPAP/High-Flow Nasal Cannula systems in ICU and ER units.
• Respond to all hospital Code Blue cardiac arrests and rapid-response alerts to perform bag-valve-mask ventilation, airway management, and endotracheal intubation assistance.
• Perform radial arterial punctures and draw samples from arterial lines to analyze Arterial Blood Gases (ABGs — pH, PaCO2, PaO2, HCO3, lactate) and adjust ventilator settings.
• Administer medical gases (oxygen, heliox, inhaled nitric oxide for pulmonary hypertension), nebulized bronchodilators, and neonatal exogenous surfactant.
• Perform airway clearance therapies, endotracheal/tracheostomy suctioning, chest physiotherapy, and bedside extubations.
• Conduct diagnostic Pulmonary Function Tests (spirometry, lung volumes, diffusing capacity DLCO) in outpatient pulmonology clinics.

3. Education Requirements & Accredited Schools

Becoming a respiratory therapist requires graduating from a two-year Associate of Applied Science (AAS) degree or four-year Bachelor of Science in Respiratory Therapy (BSRT) program accredited by the Commission on Accreditation for Respiratory Care (CoARC).

The curriculum combines cardiopulmonary anatomy and physiology, acid-base chemistry, respiratory pharmacology, mechanical ventilation physics, neonatal/pediatric respiratory care, and hemodynamic monitoring with 800 to 1,000+ hours of supervised hospital clinical rotations in adult ICUs, ERs, NICUs, and PFT labs.

4. National Certification Exams & State Licensure

All 50 states (except Alaska, where national certification is standard for hospital credentialing) require Respiratory Therapists to hold a State Respiratory Care Practitioner License. National credentialing is administered by the National Board for Respiratory Care (NBRC) via the Therapist Multiple-Choice (TMC) Examination and the Clinical Simulation Examination (CSE).

Achieving the low-cut score on the TMC earns the Certified Respiratory Therapist (CRT) credential, while achieving the high-cut score on the TMC and passing the Clinical Simulation Exam earns the gold-standard Registered Respiratory Therapist (RRT) credential demanded by most acute care hospitals. RRTs can also earn specialty credentials as a Neonatal/Pediatric Specialist (RRT-NPS), Adult Critical Care Specialist (RRT-ACCS), or Registered Pulmonary Function Technologist (RPFT).

5. Salary Percentile Breakdown & Top-Paying Settings

Compensation for a Respiratory Therapist varies based on clinical experience, specialty certifications, shift differentials, geographic region, and facility type.

6. Work Environment & Career Advancement Ladder

Primary Employment Settings: Hospital adult, pediatric, and neonatal ICUs (MICU/SICU/NICU), emergency departments, pulmonary function labs, sleep centers

7. 50-State Licensure, Compact Status & Regulatory Directory

Use the interactive directory below to review state regulatory boards, interstate compact participation, and license renewal requirements for Respiratory Therapist professionals across all 50 states and Washington, D.C.