Take a deep breath: What to know before becoming a respiratory therapist

Key takeaways:

• More respiratory therapists are needed following the COVID-19 pandemic.
• Respiratory therapists work in a variety of places.
• Individuals interested in this career start by completing an associate degree program.

Individuals with an interest in pulmonology and helping patients with breathing problems might also want to consider a career in respiratory therapy.

Respiratory therapists (RTs) can be found providing care in a variety of places including ICUs, pulmonary rehabilitation programs, sleep laboratories and smoking cessation programs.

Over recent years, RTs have become prominent figures in acute care settings. The COVID-19 pandemic called attention to the importance of respiratory therapy for patients with severe infections.

To gain more insight on an RT’s role in the health care system, why more RTs are needed in today’s world and how to start the process of becoming an RT, Healio spoke with Mike Hess, MPH, RRT, RPFT, respiratory therapist and senior director of patient outreach and education at the COPD Foundation.

Healio: Could you outline what an RT does on a day-to-day basis? What are some locations/programs where RTs work?

Hess: The day-to-day job is going to vary widely depending on where one works. RTs working in ICUs are going to work side-by-side with nurses and critical care physicians to assess how ventilators and patients are interacting so that additional lung injury can be avoided and people can come off the vent faster.

Out on general care floors, RTs will be administering a variety of therapies, including inhaled medications, airway clearance methods and even some symptom management teaching. They’ll also be evaluating the current care plan and suggesting changes to move the patient closer to discharge.

An increasing number of RTs are working away from the bedside as well. We’ve always been found in pulmonary function testing (PFT) labs and pulmonary rehabilitation programs (which develop monitored exercise programs and personalized educational plans that better equip patients to self-manage their breathing problems). These days, with growing awareness of the importance of care coordination to outcomes, more and more RTs are being hired into care coordinator/care navigator/care manager roles. These RTs work to smooth the transition from hospital to home, arranging for home medical equipment, recommending medication and other therapy orders, and again teaching folks how to manage their condition.

RTs are also increasingly in outpatient offices, doing tobacco cessation programs, care coordination from that perspective, inhaler device training — basically anything a person needs to breathe easier.

Still other RTs are working in the ever-growing telehealth arena. The Ambulatory and Post-Acute Care membership section of the American Association for Respiratory Care (AARC) has actually identified almost two dozen additional areas where RTs can be found. These include places you might not expect to find an RT, such as organ recovery, electronic medical record providers and even payers (insurance companies).

Healio: How do the duties of an RT differ from a nurse?

Hess: RTs are different than nurses because we’re specialized. We receive far more training specific to the lungs than RNs in an equivalent program. We’re responsible for knowing the heart and lungs inside and out and coming up with ideas on how to fix problems in those areas. Nurses have a much broader responsibility and need the broader knowledge base that goes with that.

Healio: If an individual is interested in becoming an RT, what education and credentials are required? On average, how long does it take to become an RT?

Hess: The basic program is a 2-year (often 3 years, depending on prerequisite classes) associate degree program. Graduates of these programs are eligible to sit for our credentialing examination. Those who pass the exam at the minimum cut score are designated “certified respiratory therapists” (CRTs). Those who pass at a higher level are eligible to take a clinical simulation exam; upon passing, they are designated “registered respiratory therapists” (RRTs).

This two-tier system is a holdover from the early days of RT when many therapists were trained on the job. Back then, the RRT indicated a therapist with a degree. Because of legal complications arising from licensure, we’ve been kind of stuck with this two-tier system for decades. However, our credentialing body (the National Board of Respiratory Care) is working to take steps to make the process a little more streamlined. In 2027, the two exam sessions will be consolidated into one; we will still have two cut levels and two credentials, but the burden on the applicant will be lower.

As with our friends in nursing, many hospitals are asking RTs to complete a bachelor’s degree. I think this is a really good thing; an associate degree teaches us how to do our jobs, but a bachelor’s does a better job of teaching us why. It helps us become better communicators, better advocates for our patients and ourselves, and it helps us better understand the overall health care system and our role in it. The benefits aren’t always immediately clear at the bedside in the middle of a code blue, but they’re absolutely there.

Healio: What different types of specialized care can RTs provide?

Hess: Before joining the COPD Foundation, I worked in a primary care office. Studies tell us that the average primary care visit is about 15 minutes long and covers six different topics. Readers can probably relate to how busy their PCP is by thinking back to their last visit with them. It’s really difficult for a PCP to provide extensive care or deep dives into symptoms (not to mention the documentation associated with it) under that kind of time crunch. However, they can take 30 seconds and say, “Hey, I think I’d like you to speak with our RT for a few minutes. They can help get to the bottom of these issues.” Then I could spend more time doing real counseling about smoking, making sure they have all the referrals they need and ensuring their prescribed inhalers were actually working for them.

It’s not much different in the hospital. An ICU doctor simply does not have the time to monitor, evaluate and adjust all of the settings on a modern intensive care ventilator. An ICU nurse has plenty on their plate already, too. You can think of us like Scotty to the doc’s Captain Kirk (or Mr. La Forge to Captain Picard, if you prefer). The captain doesn’t need to know how to fix the warp drive, they just need to know someone who does and who can do it right away.

Healio: Considering the COVID-19 pandemic and current climate, why do we need more RTs?

Hess: Two big reasons: attrition and a growing understanding of the importance of lung health. The pandemic was rough on every sector of health care, and we lost a lot of good people. Some we lost to overwork or moral injury (also known as burnout), some we lost to the virus itself.

Frontline disciplines such as RT were some of the hardest hit. We were already running short in parts of the country before 2020, in no small part because people didn’t really know about us. Between that attrition and changing models of health care delivery, we need more allied health professionals all over, especially RTs. Our leadership bodies (AARC, NBRC and the Coalition for Accreditation for Respiratory Care, which oversees RT schools) have joined together for a campaign called The World Needs More RTs that does a nice job of explaining why this career is a great choice.

Healio: As an RT yourself, what do you enjoy most about the job?

Hess: The variety and the sense of contribution, without a doubt. In my career, I have been around for first breaths and last breaths. I’ve seen people go from being on maximum life support and on the brink to strolling out the hospital’s front door with their families. I’ve had people tell me, “Wow, I really hadn’t realized how bad my breathing had gotten until you made it better.” I’ve sat and mourned with colleagues and families and helped bring closure and peace.

This career has also given me incredible life experiences. I’ve lobbied both in my state capital of Lansing, Michigan, and up on Capitol Hill in Washington, D.C. I’ve traveled the country, meeting other professionals and patients alike. I’ve contributed to increasing our knowledge of how to best manage conditions such as COPD, and I’ve contributed to teaching others how to help others manage their breathing. What’s not to love about that?

Healio: What advice do you have for individuals interested in respiratory therapy?

Hess: Keep an open mind about what you want to do with your career. A lot of people get stuck in the mindset that they’ll be in essentially the same job for their entire career. When I started out, I thought I would be an intensive-care guy all the way. I enjoyed that I could kind of go in, do my technical stuff and go back into the shadows. But that got old after a while, and I absolutely love building relationships, both back in my primary care days and now as an advocate. The opportunities are out there!

Also, get involved. Career and personal development opportunities often come at unexpected times, but department and hospital meetings are a great way to start learning about what’s keeping your leadership up at night, which gives you an opportunity to have an impact. Involvement in professional organizations such as AARC also gives you the opportunity to find mentors throughout your career, as well as see ways to enhance your skills and connections.

For more information:

Mike Hess, MPH, RRT, RPFT, can be reached at mhess@copdfoundation.org.

Reference:

• Be an RT. https://be-an-rt.org/. Accessed March 22, 2024.