Guide to Registered Respiratory Therapist (RTT) Certification

As a respiratory therapist who has spent nearly a decade in high-acuity pediatric emergency and ICU settings, I’ve seen firsthand how advanced training and credentialing directly translate to safer care, stronger clinical judgment, and better outcomes for patients and teams alike.

One of the most important milestones in a respiratory therapist’s career is earning Registered Respiratory Therapist (RRT) certification. Whether you’re early in your career or practicing as a Certified Respiratory Therapist (CRT) and considering your next step, understanding RRT certification can help you make an informed decision about your professional future. RRT certification is also a key requirement for many travel respiratory therapist jobs, and staying informed about eligibility and exam structure can help you plan your next career move.

Let’s break it down—what RRT certification is, how to qualify, what the exams involve, and why this credential continues to set the standard in respiratory care.

What is Registered Respiratory Therapist (RRT) Certification?

Registered Respiratory Therapist certification is the advanced professional credential awarded by the National Board for Respiratory Care (NBRC). It represents the highest level of entry-to-practice credential in the respiratory therapy profession.

While CRT certification confirms foundational competency, RRT certification validates advanced clinical knowledge, critical thinking, and decision-making skills across a wide range of patient populations and care settings—from neonatal and pediatric ICUs to adult critical care and emergency departments.

In many hospitals and specialty units, RRT certification is no longer optional, it’s the expectation.

Clinicians with a CRT may qualify for certain roles when facilities accept it, but the RRT credential is more widely required and provides greater access to critical care, emergency, and travel respiratory positions.

Eligibility and Requirements for RRT Certification

Before you can earn RRT certification, you must meet specific education and credentialing requirements set by the NBRC. These requirements ensure that candidates have the necessary foundation in respiratory care and the clinical preparation needed for advanced practice.

Basic eligibility includes:

• Graduation from a Commission on Accreditation for Respiratory Care (CoARC)-accredited respiratory therapy program
• Successful completion of the Therapist Multiple-Choice (TMC) Examination at the higher cut score
• Eligibility to sit for the Clinical Simulation Examination (CSE)

Most graduates begin by taking the TMC exam shortly after completing their program. Achieving the higher cut score is what qualifies you to move forward in the RRT process and demonstrates readiness for advanced clinical assessment and decision making. Your TMC performance determines whether you can progress to the CSE, which is required for many critical care, emergency, and travel respiratory therapist roles.

Understanding the RRT Exams

Earning RRT certification requires passing two separate NBRC examinations, each designed to measure different aspects of respiratory care competency. The TMC exam evaluates core knowledge, while the CSE assesses clinical reasoning and decision making in patient care scenarios.

Therapist Multiple-Choice (TMC) Examination

The TMC exam measures foundational and advanced respiratory therapy knowledge across key clinical domains. Content areas include: This exam evaluates your knowledge of:

• Patient assessment and data evaluation
• Equipment and troubleshooting
• Therapeutic procedures
• Infection control and safety
• Neonatal, pediatric, and adult respiratory care

Scoring at or above the higher cut score is required to qualify for RRT certification. This score indicates readiness for advanced practice and determines eligibility to move forward to the Clinical Simulation Examination.

Clinical Simulation Examination (CSE)

The CSE evaluates your ability to apply clinical knowledge in realistic patient care situations. Instead of standalone questions, the exam presents evolving scenarios that require you to:

• Interpret and prioritize clinical data
• Select appropriate diagnostic and therapeutic interventions
• Modify treatment plans based on patient responses
• Demonstrate effective clinical judgment in high acuity settings

The CSE closely reflects real world respiratory care and is a key factor in preparing clinicians for critical care, emergency medicine, and travel respiratory therapist roles.

Study Resources for RRT Certification Exams

Preparation is essential for success on both the TMC and CSE examinations. Clinicians who combine structured study materials with real clinical reasoning tend to perform more confidently on exam day. Using a mix of practice tests, review courses, and scenario based learning can help strengthen both knowledge and decision making skills.

Highly recommended RRT certification study resources include:

• NBRC official practice exams
• Kettering National Seminars review materials and simulations
• Lindsey Jones study guides and audio resources
• Egan’s Fundamentals of Respiratory Care, a commonly used textbook for TMC and CSE exam preparation and foundational respiratory therapy review
• Respiratory Therapy Review textbooks
• Mobile apps and question banks designed specifically for the TMC and CSE

It can also be helpful to review real patient cases from your clinical experience. Asking why each intervention is chosen and practicing scenario based thinking supports the type of critical reasoning evaluated in both exams, especially the CSE.

Benefits of Earning RRT Certification

RRT certification is more than a professional milestone. It is a recognized indicator of advanced clinical skill and one of the most effective ways to grow your career in respiratory care. Many employers prefer RRT status for high acuity units, and facilities often use it as a benchmark when evaluating readiness for critical care and emergency positions.

Key benefits include:

• Expanded job opportunities, especially in ICUs, emergency departments, and specialty units
• Higher earning potential and increased competitiveness for travel assignments
• Professional credibility and recognition among interdisciplinary teams
• Preparation for advanced credentials, such as Neonatal/Pediatric Specialty (NPS) or Adult Critical Care Specialist (ACCS)
• Greater confidence in high-stakes clinical decision-making

From a patient care perspective, RRT prepared clinicians bring a higher level of assessment, reasoning, and intervention skills to complex respiratory cases. This depth of knowledge supports safer care and stronger outcomes in high acuity environments.

Cost of RRT Certification

The cost of earning RRT certification depends on the required NBRC examinations. Candidates should plan for the following fees when preparing for the TMC and CSE exams:

• Therapist Multiple-Choice (TMC) Exam: approximately $190 per attempt
• Clinical Simulation Examination (CSE): approximately $200

If retesting is required, additional fees apply. Because the RRT credential is considered a core professional requirement for respiratory therapists, most employers do not cover the cost of these examinations. Travel staffing agencies, including Nomad, typically provide reimbursement or support for job related credentials such as state licensure or life support certifications like ACLS, PALS, or NRP, but not for the RRT exam itself.

Cost of Maintaining and Renewing RRT Certification

The NBRC does not charge an annual fee to maintain your credential, but renewal is required every five years.  The NBRC’s Credential Maintenance Program (CMP) includes a total renewal fee of approximately $125 for the five year renewal cycle. Respiratory therapists can renew through one of two pathways:

• Continuing education (typically 30 continuing education credits per cycle)
• Retaking the examination

Although retaking the examination is an available renewal option, most clinicians choose the continuing education pathway because it is more practical and cost effective. The exam retake is generally not recommended unless a clinician prefers that approach or is unable to meet the CEU requirements.

Clinicians who hold additional NBRC specialty credentials, such as Neonatal Pediatric Specialty (NPS) or Adult Critical Care Specialist (ACCS), should ensure that their continuing education includes credits related to the patient populations or specialty areas covered by those certifications. Some states also require their own profession specific CEUs to maintain state licensure, which can add additional cost and planning to the renewal process. State boards may also require that a portion of CEUs be completed through live or interactive learning, even though the NBRC does not specifically mandate live CE for credential renewal.

The overall cost of maintaining your RRT credential depends on how you complete your CEUs. Clinicians often meet these requirements through online CE courses, live webinars, conferences, hospital based education, or paid CEU membership platforms. There are many opportunities to earn free CEUs through professional organizations and employer programs, and renewing life support certifications such as BLS, ACLS, PALS, or NRP typically provides CE credits as well.

It is also important to keep copies of all CEU certificates and course records. The NBRC may conduct audits during the renewal cycle, and clinicians who are selected must provide documentation for all CE activities.

Because the RRT credential is considered a core professional requirement, most employers and travel staffing agencies do not reimburse for its renewal. However, travel agencies, including Nomad, may reimburse job related credentials such as state licensure or life support certifications when they are required for a specific travel assignment.

Why RRT Certification Matters—now more than ever

Demand for RRT certified clinicians continues to increase across hospitals, outpatient facilities, and travel assignments. Many organizations now prefer or require the RRT credential for critical care, emergency departments, neonatal and pediatric units, and other high acuity respiratory care settings. As patient needs become more complex, employers rely on RRT prepared clinicians for advanced assessment, problem solving, and independent clinical decision making.

The RRT credential also provides a significant advantage for clinicians interested in travel respiratory therapist jobs. Facilities frequently select RRT certified candidates because they are trained to practice confidently with less onboarding time and can step into specialty units with stronger clinical readiness. This often translates into access to more job opportunities and higher earning potential.

RRT certification is also important for long term career growth. It is the foundational requirement for advanced NBRC credentials such as Neonatal Pediatric Specialty (NPS), Adult Critical Care Specialist (ACCS), Sleep Disorders Specialty (SDS), and the Certified Pulmonary Function Technologist (CPFT) credential. Clinicians who plan to advance into specialty practice, leadership, or higher paying roles benefit from earning the RRT as early as possible.

For clinicians who want to expand their role, increase mobility, or secure more competitive travel assignments, the RRT credential remains one of the strongest investments in the respiratory therapy profession.

Related Reading

• What Earns a 5-star Facility Rating from Travel Clinicians?

• Why Magnet® Hospitals Matter & Why Travel Clinicians Want to Be There
• The Zero Harm Imperative: High Reliability in Healthcare & Aviation