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Respiratory Therapy

Respiratory therapy is the science of treating breathing difficulties. Respiratory therapists work with a broad swath of patients who all experience breathing problems of some kind, from neonates with underdeveloped lungs to adults with chronic asthma. Such work requires a high degree of compassion and exacting attention to detail, but it also demands a sophisticated knowledge base.

Typical duties of a respiratory therapist

Employed primarily in hospitals (but occasionally working in nursing facilities or as in-home care providers), respiratory therapists work closely with patients and their primary physicians to address breathing disorders that run the gamut from underdeveloped lungs to asthma, emphysema and emergency-induced respiratory problems.

In addition, respiratory therapists in some hospitals specialize in a specific area of practice, such as diagnosing breathing problems for people who suffer from sleep apnea, or providing counsel to people who wish to quit smoking.

Respiratory therapists (RTs) who work at hospitals typically work eight and twelve hour shifts, every other weekend and rotating holidays. Some hospitals have RTs work 12-hour shifts only three days per week. There may also be opportunities for overtime work. Pulmonary rehabilitation, pulmonary diagnostics and pulmonologists' offices are typically open 8 a.m.-5 p.m., Monday through Friday with weekends and holidays off.

Duties for respiratory therapists include, but are not necessarily limited to the following:

  • Evaluate patients with breathing or cardiopulmonary disorders
  • Develop treatment plans alongside physicians
  • Supervise respiratory therapy technicians
  • Administering mechanical ventilation by setting up and adjusting life support machines that breathe for patients when they cannot breathe for themselves.
  • Maintaining a patient’s airway by placing a tube in their lungs if they stop breathing, which is called intubation, bagging with an ambu bag, and administering aerosol therapy to improve airway patency.
  • Administering nebulizers with a bronchodilator may be used to treat patients with COPD, bronchitis, and pneumonia.
  • Administering Metered Dose Inhalers (MDI) to treat patients with COPD and bronchitis.
  • Administering Chest Physiotherapy (CPT), which involves chest percussion and postural drainage to certain areas of the chest. This can be done manually or with a pneumatic percussor. CPT may be used in the treatment of pneumonia or cystic fibrosis to mobilizes secretions that are retained in the lung.
  • Administering Incentive Spirometry (IS), which is also referred to as sustained maximal inspiration (SMI), and is important for post surgical patients to ensure the patient does deep breathing and coughing techniques for lung expansion.
  • Administering Continuous Positive Airway Pressure (CPAP) and Bi-Level Positive Airway Pressure (BIPAP) are used for Obstructive Sleep Apnea to keep the airway open during sleep.
  • Administering Positive Expiratory Pressure (PEP) Therapy, which is a breathing treatment that applies positive pressure during exhalation to keep the airway open. This therapy also helps with secretion removal or with collapsed areas of the lung.
  • Administering Oxygen Therapy involves several different types of devices that are used to keep the patient’s oxygen saturation up so that their cardiopulmonary system can work more efficiently.
  • Conduct arterial blood gas analysis, which involves drawing blood from an artery and interpreting the results.
  • Perform Pulmonary Function Tests either in a pulmonary function lab or at the bedside of a patient in the hospital. 
  • Perform weaning parameters on patients who are on mechanical ventilation to evaluate whether they are ready to be removed from the ventilator.
  • Serve as a 1st responder on rapid response teams.

How to become a respiratory therapist

A job as a respiratory therapist can offer a personally rewarding career in a well-paying and well-respected industry, but without the costly and time-consuming commitments to education that are so typical of other jobs in the healthcare field.

Respiratory therapists typically hold associate degrees, but some employers may prefer to hire candidates with bachelor's degrees. Respiratory therapy programs are common throughout the American collegiate system; institutions ranging from four-year universities to vocational schools offer specialized education and training to students pursuing careers as respiratory therapists.

Degree Programs

The US Bureau of Labor Statistics (BLS) reports that while respiratory therapists need at least an associate degree, some hospitals prefer to hire applicants who hold bachelor's degrees. Research your area to determine the level of demand for respiratory therapists; it varies substantially from place to place, and having a four-year degree can give you an advantage in an already-crowded sea of candidates.

Respiratory therapy programs combine classroom time with dedicated lab hours, during which students can practice their new-found skills in a realistic clinical setting. Programs offered by respiratory therapy schools can include some general coursework that would be common of most all medically related technical fields. These courses can provide a framework upon which more specialized career oriented training can be built.

Respiratory therapy programs are predictably science-heavy. The basic classes that would be part of an associate degree program or the general undergraduate requirements of a bachelor’s program in respiratory care would include:

  • Therapeutic and diagnostic procedures
  • Microbiology
  • Pharmacology
  • Physics
  • Chemistry
  • Mathematics
  • Cardiopulmonary resuscitation (CPR)
  • Physiology
  • Pathophysiology
  • Human anatomy

Respiratory therapy programs can also address educational components that are so wonderfully unique to this profession. Because one of the core functions of a respiratory therapist is to educate those who suffer from respiratory issues, a significant portion of RT training focuses on the methods and principals of educating the public on the importance of disease prevention, while working to promote respiratory health. This may take the form of smoking cessation counseling workshops or teaching a parent the proper procedures for responding to a severe asthma attack or allergic reaction.

RT programs may also involve a level of mechanical technical education so as to prepare graduates to perform ventilator/breathing apparatus maintenance and repair. It is not uncommon for administrative training in medical records keeping and office management to also be part of bachelor’s programs specific to respiratory therapy.

Some respiratory therapy schools may also require ancillary courses that deal with topics such as ethics or adult critical care. Programs offer dedicated lab time that allows students to gain ample experience in a clinical setting while earning course credits they can apply towards their degrees.

Certification and Licensure

All US states except Alaska require respiratory therapists to be licensed. Certification may be required in order to obtain a license in your state. Some states don't require a CRT or RRT in order to practice respiratory therapy, but employers across the country recognize the certification as the gold standard of educational achievement in this field. Regardless of your location, obtaining respiratory therapy certification can make you a better-prepared job applicant.

In order to apply for respiratory therapy certification, an individual must either have graduated from and earned a minimum of an associate degree from an accredited respiratory therapy program, or be enrolled in a bachelor's degree program for respiratory care. 

After you've earned your degree, you become eligible to take the Therapist Multiple-Choice Examination (TMC), which, if passed, results in respiratory therapy certification. The TMC has two cut scores:

  • If a test-taker achieves the lower score, he earns CRT (Certified Respiratory Therapist) certification
  • If he achieves the higher cut score, he can go on to take the Clinical Simulation Examination, a passing score of which earns its taker the RRT (Registered Respiratory Therapist) certification offered by the National Board for Respiratory Certification (NBRC).

The NBRC offers two levels of certification: the CRT (Certified Respiratory Therapist) and the more advanced RRT (Registered Respiratory Therapist). Both types of certification are accompanied by prerequisites and exams. The RRT is the ultimate educational attainment in the field of respiratory therapy.

Internships

Typically programs require clinical rotations in various areas of the hospitals such as pulmonary function labs, critical care, emergency room, adult, pediatric and neonatal care. It is typical for a program to require over 1,000 clinical hours prior to graduation.

Program requirements/prerequisites

Most schools require chemistry and algebra courses to be completed prior to enrolling in a respiratory therapy program but this can vary based on the specific school. Respiratory therapists should be compassionate, detail-oriented and competent in life sciences. Patients who suffer from breathing disorders are likely to be frustrated and distraught, so respiratory therapists need to be able to offer emotional support. They should also possess great attention to detail. The ability to stay focused at all times becomes paramount when you are responsible for a patient's treatments and medications. Finally, an understanding of anatomy, physiology and related sciences ensures basic workplace problem-solving skills, such as evaluating patients' symptoms.

Accreditation

In order for students to be eligible for the National Board for Respiratory Care (NBRC) exams, they must graduate with a minimum of an associate’s degree from an accredited program. Without accreditation, the school cannot graduate respiratory therapists. Programs are accredited through the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and facilitated by the Committee on Accreditation for Respiratory Care (CoARC). In order for programs to become accredited they must submit an application, submit self study documents, and have the accrediting body visit and approve their program. The accreditation status is reviewed every three to ten years.

Employment settings for respiratory therapists

  • Hospitals
    Respiratory therapists generally rotate to various units of the hospital such as the emergency room, adult intensive care unit (ICU), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), post anesthesia intensive care units (PACU), coronary care unit (CCU), the general floors, and the hospice units. Therefore, it is important for RTs to remain versatile. Depending on the size of the facility, respiratory therapists may be able to stay in a specialty unit such as neonatal or pediatrics. 
  • Helicopter transport units and ambulances
    With additional training, respiratory therapists who work in a large facility may become a member of the air/land transport team. Depending on the facility and need, patients may be picked up at outlying facilities or transported to them. For example, neonates who require vent management may be transported from a smaller hospital to a larger one where there is a NICU. 
  • Pulmonologists’ offices
    Respiratory therapists at pulmonologists’ offices may perform pulmonary function tests, check resting/exercise pulse oximeter, obtain arterial blood gases, and educate patients. Currently RTs in the office setting are not reimbursable by insurance companies. However, there is legislation in Congress to allow for reimbursement
  • Sleep Laboratories
    Respiratory therapists are involved in setting up of sleep testing, monitoring patients, scoring sleep studies, and providing patients with necessary education on their disease or condition. Obstructive sleep apnea is one of the more common sleep disorders an RT works with.
  • Home Care
    RTs play an important role in the home care of patients in providing education of their disease process, medications, and modes of therapy. This may involve the education of caretakers with home ventilator patients from infants to geriatric patients.
  • Cardio/Pulmonary Rehabilitation
    Experienced RTs with an advanced degree can work with respiratory and cardiac patients to help them improve their endurance and quality of life through exercise. Cardio and Pulmonary rehabilitation is typically located in a hospital setting but some are located in physical therapy practices.
  • Pulmonary Diagnostics
    Respiratory therapists can perform pulmonary function diagnostic testing to help determine the type and extent of respiratory diseases. Typically these departments are located within hospital settings.
  • Travel companies
    Contractual travel companies hire experienced respiratory therapists for a variety of facilities nationwide due to there being shortages for these professionals. The contracts may vary from 12 to 24 weeks or longer. Each contractual company is different so the need for self-education is a must.
  • Sales representatives
    Experienced RTs with an advanced degree can become sales representatives for pharmaceutical companies or medical equipment companies.
  • Education
    Respiratory Therapists can work as educators in colleges and clinical settings.
  • Hyperbaric Chambers
    Some RTs work in hyperbaric chambers with individuals who need hyperbaric oxygen therapy as mentioned previously.

CAREER OUTLOOK AND SALARY INFORMATION

CareerAnnual Mean WageBottom 10% Annual WageTop 10% Annual Wage
Respiratory Therapists$61,810$43,120$83,030
Respiratory Therapy Technicians$50,900$30,990$73,330
Source: 2017 Occupational Employment Statistics and 2016-26 Employment Projections, Bureau of Labor Statistics, BLS.gov; 2016-26 State Occupational Projections, Projections Central, projectionscentral.com

The BLS notes that job prospects favor those who are willing to travel to find work. Some areas already have a surfeit of respiratory therapists, while others, often rural, are particularly in need of qualified applicants.

FAQs

What sort of questions are patients asked when they’re being “interviewed” about their symptoms?

When a patient comes in with breathing issues, there are a series of questions the respiratory therapist asks them to better understand what is going on. Some of these questions include:

  • Are you short of breath (although this may be obvious)
  • How long have you felt this way?
  • Have you had a cold?
  • Have you been coughing anything up?
  • Do you have chest pain? If so, is it constant (sign of cardiac issues) or do you just feel it with deep inhalation (sign of respiratory issues)?
  • If you have chest pain, on a scale of 1-10, with 10 being the worse pain you have ever experienced, how would you rate your pain?
  • Have you ever felt like this before?

What are the advantages of a job in this field?

One of the greatest advantages is that, as a respiratory therapist, you are the expert when it comes to the lungs. Ideally, any time there is a patient who is having trouble breathing, the RT is the first person called. Whether you are helping save the life of a heart attack patient who stopped breathing or simply educating an asthmatic, the sense of reward in making a difference in someone's life is a wonderful feeling.

Another exciting aspect of the job is working as part of a team to try to figure out how to help patients in need. While the medical field is based on science, trying to figure out what is wrong with patients and how to help them is an art.

What challenges exist with a job in this field?

The job of a respiratory therapist can be stressful since these individuals can deal with life and death situations daily. However, helping people in these high-stress situations can also be very rewarding.

Another challenge in this field is trying to help people who are not receptive to being helped. There is also the challenge of dealing with an ever-changing healthcare system where some people come to the hospital because it's free and other people may avoid coming or staying because they can't afford to pay for the services.

What opportunities exist for career advancement as an RT?

There are a variety of opportunities for advancement in the field of respiratory therapy, including education, management of departments, management of home care companies and management of transport teams. There are also hospice opportunities available. In order to advance you typically need further education or certifications. Indeed, the BLS reports that the best opportunities could be available to those willing to travel, as well as those working in rural areas.

Therapists thinking of advancement may also wish to seek certification through the National Board for Respiratory Care (NBRC), which offers two certifications, including Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT). Passing an exam is required for either certification, although the latter is the more advanced credential.

Are there certain times of the year that respiratory therapists are busier than others?

The busy season for respiratory therapists is typically autumn and winter since that is when asthma and flu seasons begin. Autumn and winter are also times when school is in session and the windows and doors are closed with heaters turned on. This causes rooms to become incubators for germs.

How do RTs handle terminally ill or other patients who have “do not resuscitate” orders?

Respiratory therapists often work with terminally ill patients and those who are on ventilators to help with breathing. RTs are limited in end of life care by "do not resuscitate" (DNR) orders. For patients who do not have a DNR order, everything must be done to help that patient breathe. There can be gray area when a patient has a partial DNR order; for instance, when the patient requests they not be given CRP but can have drugs for treatment, or when the patient allows CPR and drugs but requests no intubation. This means the respiratory therapist must mechanically ventilate with a bag mask rather than intubation by placing an endotracheal tube into the patient. Obviously, these orders can be very confusing for patients and often are not correctly explained by physicians prior to being instituted. However, the patient’s family members or the powers of attorney are allowed to make decisions for the patient at their time of need. These types of situations are traditionally handled by physicians, but families can seek education from the respiratory therapists who are helping their loved one.

How are lung and breathing disorders diagnosed?

While it is not the job of the RT to diagnose patients, after an individual works in this profession long enough, they develop this skill. Typically a respiratory therapist uses their stethoscope to determine what the problem is based on how they are breathing. How the patients’ lungs sound can provide very useful information. Asking a variety of questions and reviewing other test results like x-rays, CTs, and EKGs is also helpful. The doctor is the expert who is able to actually diagnose even when an RT has a pretty good idea of what the problem is.

How do RTs handle Code Blues?

For Code Blue emergency situations, a respiratory therapist initially makes sure the patient is breathing. If the patient isn’t breathing or gasping for air, the RT uses an Ambu-bag and mask to assist the patient or breath for him. An RT assistant or nurse will typically manage the Ambu-bag while the RT opens the airway box and set up for intubation. Then, the RT sets up a ventilator. Also at a code blue an RT may do an ABG as appropriate, and an EKG at some point. Along with these skills, the RT also works with the RN and physician in trying to figure out what is wrong with the patient and how to effectively resolve it.

How are ventilators managed?

Patients are put on ventilators for a number of reasons. Sometimes patients are put on ventilators for short term, such as in post-op heart patients, and other times patients are put on ventilators for long- term periods. Respiratory therapists setup ventilators based on physician’s orders and are responsible for making sure the ventilator is in sync with the patient’s breathing. The RT is responsible for checking the ventilator to ensure there are no changes with the patient or the machine. The ventilator should be working with the patient rather than the other way around. In the Intensive Care Unit, ventilators are typically checked every two to three hours. Respiratory therapists also participate in patient care plans and make adjustments accordingly in collaboration with the physician. The goal is to wean the patient as quickly as possible, but not before the underlying condition that led to the ventilator is resolved. With some patients this can be easy, but for others (especially COPD patients) this can be very tricky.

Ventilator care in the home is very involved due to educating the patient, family, caregiver, and nurses appropriately. There are several pieces of equipment that require education for the patient and caregiver. The patient and family or caregivers must be familiarized with every piece of equipment and taught how to suction, and how to identify a crisis situation.

What are the main types of medical equipment used in this field?

  • Intubation equipment such as a laryngoscope and bag valve mask.
  • Endotracheal tubes (ET tubes) which are placed in the airway (trachea) so breathing can be assisted.
  • Tracheostomy tubes which are placed in the trachea via an incision made below the vocal cords. This tube can provide a connection for a ventilator and a way of suctioning the airway for long term care patients.
  • CPAP/Bilevel therapy can provide one or two levels of pressure to maintain the patient’s airway.
  • Nebulizer therapy is the most commonly ordered treatment for pulmonary diseases.
  • Ventilators can provide life-sustaining therapy that may be short or long term.
  • Suction catheters are typically set up at the patient’s bedside to allow RTs to suction secretions from the lungs and mouth.
  • Arterial blood gas kits include a heparinized syringe and needle used for puncturing the artery. The arterial blood that is obtained reflects the condition of the lungs by measuring oxygen and carbon dioxide levels.
  • Pulse Oximeters are devices that measure the saturation of oxygen in the blood (hemoglobin).
  • Capnometers are devices that detect the amount of carbon dioxide in exhaled air. It is used for making sure the endotube is in the trachea rather than the stomach and can also be used continuously with mechanical ventilation to ensure that the patient is adequately exchanging air

Sources:

  • The Bureau of Labor Statistics Occupational Outlook Handbook, 2017, http://www.bls.gov/ooh/
  • The National Board for Respiratory Care, RRT Credential, http://nbrc.org/rrt/Pages/default.aspx

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