Respiratory Therapy Certification (NBRC) - Eligibility, Exams & Renewals
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Respiratory illnesses are on the rise. In 2017 a study published by the Journal of the American Medical Association found a 30 percent increase in mortality from chronic respiratory diseases. This translates into respiratory disease being responsible for one out of every 15 deaths in the US, costing more the $132 billion in health care expenses in 2013. This has, in turn, caused an increased demand for trained and certified respiratory therapists who can help treat these patients.
Respiratory therapists are critical members of any medical team, be it in an emergency room, an intensive care unit, or a doctor’s office. They treat acute breathing difficulties such as those experiencing a stroke, heart attack, or drowning. They also treat chronic breathing issues such as asthma, emphysema, and chronic obstructive pulmonary disorder (COPD). Between 2019 and 2029, there is an anticipated 19 percent growth in new jobs nationally to treat these and other breathing disorders—much higher than the average growth expected among all US occupations in the same timeframe (4 percent).
Education and certification are essential to performing this job. Professionals in this field must earn at least an associate’s degree in respiratory therapy, although many who pursue this career have bachelor’s or master’s.
Upon completing a respiratory therapy program, aspiring respiratory therapists must earn either a Certified Respiratory Therapist (CRT) or Registered Respiratory Therapist (RRT) certification through the National Board for Respiratory Care (NBRC), as it is required for licensure in 49 states. Testing for this field is rigorous and is considered one of the most challenging exams in the medical field.
Continue reading to learn about the different certifications respiratory therapists can earn, what each exam entails, and how to prepare for these exams.
Early Preparation in High School to Become a Respiratory Therapist
The career of a respiratory therapist starts as early as high school. Graduating from high school or obtaining a GED is necessary as most respiratory therapists programs require this. Students who are interested in pursuing this career should focus on courses such as biology, math, physics, and anatomy. Since respiratory therapists must also interact with patients who may have a hard time with procedures, classes such as psychology can also be helpful.
National Board for Respiratory Care (NBRC) Certification Eligibility
There are four primary and three specialty certifications offered. The eligibility requirements for each one are detailed below.
Certified Respiratory Therapist (CRT) Eligibility
To earn the CRT certification, candidates must pass the Therapist Multiple-Choice (TMC) exam. To be eligible to sit for the TMC exam, candidates must:
- Be 18 years old
- Have an associate’s in respiratory therapy from a Commission on Accreditation for Respiratory Care (CoARC) accredited program
Registered Respiratory Therapist (RRT) Eligibility
To earn an RRT certification, candidates must first earn a high pass score on the TMC exam. This gives them eligibility to sit for the Clinical Simulation Examination (CSE). In addition to the TMC high cut score, candidates must either:
- Be a CRT for four years and have 62 semester-credits of coursework, including anatomy and physiology, chemistry, microbiology, and math
- Be a CRT for two years and hold an associate’s in respiratory therapy
- Be a CRT for two years with a bachelor’s in any field and hold the Canadian Society of Respiratory Therapists (CSRT) RRT credential
Certified Pulmonary Function Technologist (CPFT) Eligibility
To earn a CPFT designation, candidates must pass the Pulmonary Function Technology (PFT) exam with a low cut score. To be eligible to sit for the PFT exam, candidates must be 18 years old and either:
- Have an associate’s in respiratory therapy from a Commission on Accreditation for Respiratory Care (CoARC) accredited program
- Be a CRT or RRT
- Have six months of clinical work experience in the field of pulmonary function and have 62 semester-credits of coursework including anatomy and physiology, chemistry, microbiology, and math
Registered Pulmonary Function Technologist (RPFT) Eligibility
To earn an RPFT designation, candidates must pass the Pulmonary Function Technology (PFT) exam with a high cut score. To be eligible to sit for the PFT exam, candidates must be 18 years old and either:
- Have an associate’s in respiratory therapy from a Commission on Accreditation for Respiratory Care (CoARC) accredited program
- Be a CRT or RRT
- Have six months of clinical work experience in the field of pulmonary function and have 62 semester-credits of coursework including anatomy and physiology, chemistry, microbiology, and math
Adult Critical Care Specialist (ACCS) Eligibility
To earn the ACCS certification, candidates must pass the Adult Critical Care Specialty (ACCS) exam. Candidates for this exam must have held an RRT certification for at least one year.
Neonatal/Pediatric Specialist (NPS) Eligibility
The NPS certification is awarded to candidates who pass the Neonatal/Pediatric Respiratory Care Specialty (NPS) exam. To be eligible for this exam, candidates must be RRTs.
Sleep Disorders Specialist (SDS) Eligibility
SDS certification is earned by passing the Sleep Disorders Specialty (SDS) exam. Candidates for this exam must be either:
- A CRT or RRT and have completed a CoARC accredited program with a sleep add-on
- A CRT for six months
- An RRT for three months
National Board for Respiratory Care (NBRC) Certification Exams
Preparation for the two certifications, one clinical simulation, and three specialty exams offered by NBRC varies. Here is an overview of each exam and which certificates they apply to:
Therapist Multiple-Choice (TMC) Certification Exam for Certified Respiratory Therapists (CRT) and Registered Respiratory Therapists (RRT)
The TMC is required for both CRTs and RRTs.
The exam score determines the certification earned and eligibility to sit for the CSE. A low cut score earns candidates a CRT credential while a high cut score earns the CRT credential and the eligibility to sit for the CSE and earn an RRT credential.
The TMC consists of 140 scored and 20 unscored pretest multiple-choice questions and takes three hours. The cost to register for this exam is $190 for the first exam and $150 for retakes. Topics covered include:
- Evaluating data in the patient’s record
- Performing a clinical assessment
- Performing procedures to gather clinical information
- Evaluating procedure results
- Recommending diagnostic procedures
- Controlling infection
- Troubleshooting devices
- Maintaining an artificial airway
- Performing airway clearance and lung expansion techniques
- Supporting oxygenation ventilation
- Administering medications and specialty gases
- Modifying respiratory care plans
- Providing care in high-risk situations
- Using evidence-based practices
- Supporting physicians in performing procedures
This exam is considered one of the hardest to pass in the entire medical field. There is no official study guide published by the NBRC, but they offer free online practice exams. They recommend contact their faculty for review materials as well as reviewing the following guidelines and standards:
- American Heart Association guidelines for resuscitation in patients who are adults, children, and neonates
- National Committee for Clinical Laboratory Standards (blood gas pre-analytical considerations: specimen collection, calibration and controls oxygen content hemoglobin, oxygen content [saturation] and related quantities in blood terminology, measurement, and reporting percutaneous collection of arterial blood for laboratory analysis tentative standard for definitions of qualities and conventions related to blood ph and gas analysis)
- AARC Clinical Practice Guidelines
- American Thoracic Society standards regarding spirometry, lung volumes, and walking tests
There is also a Self-Assessment Examination (SAE) available for purchase through the NBRC, which provides feedback about a candidate’s readiness to take the exam.
Clinical Simulation Examination (CSE) for Registered Respiratory Therapists (RRT)
Candidates who have passed the TMC with a high cut score can sit for the CSE exam to become RRTs.
This four-hour exam consists of 20 scored and two pretest unscored problems. This exam costs $200. The topics covered in the CSE are identical to the TMC, but rather than testing the ability to give a correct answer, it evaluated a candidate’s ability to case manage and think on their feet.
When candidates begin this exam, they are presented with three windows consisting of a scenario, options, and simulation history. Given the scenario in the first window, candidates must choose their options in the second. The simulation history window helps candidates keep track of the options they have already chosen.
There is no official study guide published by the NBRC, although there are sample tests available on their website. They recommend contacting faculty to get recommendations on study materials as well as reviewing:
- American Heart Association guidelines for resuscitation in patients who are adults, children, and neonates
- National Committee for Clinical Laboratory Standards (blood gas pre-analytical considerations: specimen collection, calibration and controls oxygen content hemoglobin, oxygen content [saturation] and related quantities in blood terminology, measurement, and reporting percutaneous collection of arterial blood for laboratory analysis tentative standard for definitions of qualities and conventions related to blood ph and gas analysis)
- AARC Clinical Practice Guidelines
- American Thoracic Society standards regarding spirometry, lung volumes, and walking tests
Pulmonary Function Technology (PFT) Certification Exam for Certified Pulmonary Function Technologists (CPFT) and Registered Pulmonary Function Technologists (RPFT)
Both CPFTs and RPFTs take the PFT exam. The score earned on the exam determines what certification a candidate earns. A high cut score earns the RPFT certification while a low cut score earns a CPFT certification.
This exam takes two hours and consists of 100 scored and 15 unscored pretest multiple-choice questions. The cost to take this exam is $200 for the first try and $170 for any retakes. Topics covered in this exam include:
- Setting up, maintaining, and calibrating equipment
- Troubleshooting equipment
- Performing quality control
- Selecting test protocols and equipment
- Performing procedures
- Evaluating the validity of results
- Calculating results and selecting reference ranges
- Evaluating the reliability of results
- Evaluating clinical implications
While there is no specific study guide published by the NRBC, they recommend consulting with faculty for study recommendation and studying the following resources:
- American Heart Association guidelines for resuscitation in patients who are adults, children, and neonates
- National Committee for Clinical Laboratory Standards (blood gas pre-analytical considerations: specimen collection, calibration and controls oxygen content hemoglobin, oxygen content [saturation] and related quantities in blood terminology, measurement, and reporting percutaneous collection of arterial blood for laboratory analysis tentative standard for definitions of qualities and conventions related to blood ph and gas analysis)
- AARC Clinical Practice Guidelines
- American Thoracic Society standards regarding spirometry, lung volumes, and walking tests
A practice exam is available on the NRBC website. This exam not only gives candidates a feel for the style of questions but also can be a good indicator of what needs to be studied. As part of exam preparation, candidates can also purchase and take a Self-Assessment Examination (SAE) on the NBRC website. This exam informs candidates about the areas they should focus on studying and provides the rationale for the correct answers.
Adult Critical Care Specialist (ACCS) Certification Exam
The ACCS certification is earned by passing the ACCS exam. This exam is four hours long and consists of 150 scored and 20 pretest unscored multiple-choice questions. The cost of this exam is $300 for the first attempt and $250 for any retakes. Topics covered in this exam include:
- Respiratory critical care
- How to manage airways
- Delivering pharmaceuticals
- Assessing patient status as well as any changes in their status
- Anticipating care based on lab results
- Anticipating care based on imaging results
- Anticipating results of pharmaceuticals
- Anticipating care based on nutritional status
- Recognizing and managing infection and sepsis
- End of life care
- Preparing for disaster and mass casualty events
- Performing procedures
- Troubleshooting
The NBRC does not publish official study guides for their exams. They offer online practice exams, suggest consulting faculty for recommendations on study materials, and recommend reviewing the following resources:
- American Heart Association guidelines for resuscitation in patients who are adults, children, and neonates
- National Committee for Clinical Laboratory Standards (blood gas pre-analytical considerations: specimen collection, calibration and controls oxygen content hemoglobin, oxygen content [saturation] and related quantities in blood terminology, measurement, and reporting percutaneous collection of arterial blood for laboratory analysis tentative standard for definitions of qualities and conventions related to blood ph and gas analysis)
- AARC Clinical Practice Guidelines
- American Thoracic Society standards regarding spirometry, lung volumes, and walking tests
A Self-Assessment Examination (SAE) is available on the NBRC website to help candidates determine what they still need to study. Candidates can review their responses, incorrect answers, and the rationale for the correct answer.
Neonatal/Pediatric Specialist (NPS) Certification Exam
The NPS certification exam takes three hours and consists of 120 scored and 20 unscored pretest multiple-choice questions. It costs $250 to take this exam the first time and $220 for any subsequent retakes. Topics covered in this exam include:
- Assessing patient information
- Evaluating a patient’s pulmonary status
- Assessing and managing airways
- Selecting and managing equipment
- Facilitating procedures and evaluating efficacy
- Managing and anticipating effects of medication administration
- Anticipating care based on lab results
- Anticipating care based on imaging results
- Anticipating results of pharmaceuticals
- Anticipating care based on nutritional status
- Assisting with or performing resuscitation
- Preparing for disaster or mass casualty events
- Managing special gas administration
- Competencies related to critical care
- Managing ventilation and oxygenation
- Preventing hospital-acquired conditions
- Managing end of life care
Practice exams are available on the NBRC website to help candidates prepare for the exam. There are no official study guides published by the NRBC, although they recommend consulting coursework completed, contacting faculty for study recommendations, and reviewing the following resources:
- American Heart Association guidelines for resuscitation in patients who are adults, children, and neonates
- National Committee for Clinical Laboratory Standards (blood gas pre-analytical considerations: specimen collection, calibration and controls oxygen content hemoglobin, oxygen content [saturation] and related quantities in blood terminology, measurement, and reporting percutaneous collection of arterial blood for laboratory analysis tentative standard for definitions of qualities and conventions related to blood ph and gas analysis)
- AARC Clinical Practice Guidelines
- American Thoracic Society standards regarding spirometry, lung volumes, and walking tests
An additional study step that can be taken is to take a Self-Assessment Examination (SAE) on the NBRC website. The SEA not only informs candidates of the areas they need to focus on but gives them the reasoning behind the correct answers.
Sleep Disorders Specialist (SDS) Certification Exam
The SDS exam is four hours long and consists of 160 scored and 20 unscored pretest multiple-choice questions. It is the longest exam offered by the NBRC. This exam costs $300 for the first time and $250 for any retakes. The topics covered in this exam are:
- Identification and caring of at-risk individuals
- Preparing for a study
- Signal maintenance during testing
- Sleep-related disorders and therapeutic interventions
- Documentation during testing
- Study conclusions
- Record review
- Sleep staging
- Sleep event identification
- Sleep event reporting
- Data and equipment maintenance
- Developing a treatment plan
- Implementing a treatment plan
- Evaluating a treatment plan
While there are no official study guides published by the NBRC, there are several ways candidates can prepare for this exam. First, taking the Self-Assessment Examination (SAE) for purchase on the NBRC website provides a guideline for what a candidate may still need to study. Second, taking the free practice exam on the NBRC website helps candidates familiarize themselves with the exam format and questions and practice their knowledge. Lastly, the NBRC recommends reviewing the following resources:
- American Heart Association guidelines for resuscitation in patients who are adults, children, and neonates.
- National Committee for Clinical Laboratory Standards (blood gas pre-analytical considerations: specimen collection, calibration and controls oxygen content hemoglobin, oxygen content [saturation] and related quantities in blood terminology, measurement, and reporting percutaneous collection of arterial blood for laboratory analysis tentative standard for definitions of qualities and conventions related to blood ph and gas analysis)
- AARC Clinical Practice Guidelines
- American Thoracic Society standards regarding spirometry, lung volumes, and walking tests
NBRC Certification Renewals
All certifications issued by the NBRC have the same renewal requirements. Credentials are valid for five years. An annual fee of $25 must be paid, for a total of $125 for a credentialing period. To renew, certificate holders must meet the Credential Maintenance Program requirements, which are to either:
- Complete quarterly assessment for the credential held and provide proof of 30 up hours of continuing education; hours are determined by the scores earned on the quarterly assessments
- Retake and pass the credentialing examination for the highest certificate held
- Pass an NBRC credentialing exam for a certificate not previously held
State Licensure for Respiratory Therapists
Respiratory therapists are required to be licensed in every state, except Alaska.
Licensing is issued by a state’s licensing board and is an additional step from certification. Requirements for licensing vary by state, so candidates should contact their local board to ensure they have the necessary qualifications. As an example, the requirements for respiratory therapists in California are:
- Complete a CAAHEP accredited respiratory therapy program
- Pass the TMC exam with a low cut score to be a CRT OR pass the TMC with a high cut score and pass the CSE to be an RRT
- Complete a Law and Professional Ethics Course with either the California Society for Respiratory Care (CSRC) or the American Association for Respiratory Care (AARC)
- Pass a background check
- Submit a completed application
- Pay $300 application fee
