Qualifying for CRT and RRT Certification

In addition to state licensure, qualifications for respiratory therapists in the U.S. are often measured by professional certification. Certification through the National Board for Respiratory Care, Inc. (NBRC) not only demonstrates that a respiratory therapist has met minimum licensing requirements, but may also demonstrate advanced-level training and specialized skills in the respiratory therapy profession.

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Why NBRC Certification?

The National Board for Respiratory Care (NBRC) is a not-for-profit, voluntary credentialing board that is sponsored by four, professional organizations, including the American Association for Respiratory Care (AARC).

The NBRC and its respiratory therapist certifications have become an industry standard across the country, with all 49 states that license respiratory therapists using them to ensure that recent RT program graduates possess the skills and knowledge necessary to be eligible for licensure. Even in Alaska, where there is no state licensure, respiratory therapists use NBRC credentials to distinguish themselves in a competitive profession.

The NBRC, which has been credentialing respiratory therapists since 1960 (It was originally called the American Registry of Inhalation Therapists.), has a clear set of missions, which include:

  • To provide high-quality, voluntary credentialing examinations
  • To establish standards to credential respiratory therapists
  • To advance medicine through the promotion of respiratory care
  • To support ethical and educational standards for respiratory care
  • To support respiratory education through cooperative efforts with accrediting agencies

The NBRC states that respiratory therapists credentialed by the NBRC frequently receive higher salaries and premium employment opportunities. Further, the NBRC’s credentials, because they are recognized nationally, simplify the mobility process for respiratory therapists relocating from one state to the next.

To date, the NBRC offers the following credentials:

  • Certified Respiratory Therapist (CRT)
  • Registered Respiratory Therapist (RRT)
  • Neonatal/Pediatric Respiratory Care Specialist (CRT-NPS or RRT-NPS)
  • Sleep Disorders Specialist (CRT-SDS or RRT-SDS)
  • Certified Pulmonary Function Technologist (CPFT)
  • Registered Pulmonary Function Technologist (RPFT)

The CRT and the RRT credentials are considered to be the standards for licensure. All states require respiratory therapists to possess the CRT credential, while a few states, including Ohio, California and New York, now also require licensed respiratory therapists to possess the RRT credential. These standard certifications must also be achieved before respiratory therapists can pursue the NBRC’s specialty certifications.

Certified Respiratory Therapist (CRT): Qualifying for CRT Certification

The Certified Respiratory Therapist (CRT) credential is the NBRC’s entry-level credential that has become a standard for state licensure. Before state licensing can take place, candidates must earn the CRT credential by passing   the Therapist Multiple-Choice (TMC) Examination.

To qualify to sit for the exam, candidates must be graduates of respiratory therapy programs that have been accredited by the Commission on Accreditation for Respiratory Care (CoARC). There are currently 441 CoARC-accredited programs in respiratory therapy available across the United States, the majority of which are at the associate degree level, but many of which are available at the bachelor’s level.

The Therapist Multiple-Choice (TMC) Examination is designed to test a graduate’s knowledge and skills required to enter practice. It consists of 160 multiple-choice questions in three content areas:

  • Patient Data Evaluation and Recommendations
  • Troubleshooting and Quality Control of Equipment and Infection Control
  • Initiation and Modification of Interventions

Test takers are given three hours to complete the examination. To qualify to take the CRT examination, candidates must be at least 18 years old and have either:

  • Graduated from a CoARC-accredited associate’s degree program in respiratory therapy


  • Be in the process of completing a CoARC-accredited bachelor’s degree in respiratory therapy but far enough into the process that the content requirements to sit for the examination have been met

Candidates that currently hold the Canadian Society of Respiratory Therapists (CSRT) credential are also qualified to sit for the CRT examination.

Registered Respiratory Therapist (RRT): Qualifying for RRT Certification

The Registered Respiratory Therapist (RRT) credential is the advanced credential that may be pursued by graduates of CoARC-accredited respiratory therapy programs or CRTs who possess at least four years of clinical experience following their CRT certification. The latter must also possess the required college credit hours, including specific basic science courses.

The RRT examination process involves passing the same Therapist Multiple-Choice (TMC) Examination required for the CRT credential, but with a higher score, as well as a Clinical Simulation Examination (CSE).

The Clinical Simulation Examination (CSE) consists of 22 separate patient management problems (20 of which are scored), all of which are designed to simulate real clinical practice scenarios. Test takers are given four hours to complete this portion of the examination.

Respiratory therapists must meet one of the following to quality to sit for the Clinical Simulation Examination (CSE):

  • Be a recent graduate of an associate or bachelor’s degree program in respiratory care accredited by CoARC, then complete the Therapist Multiple-Choice (TMC) Examination with the higher cut score necessary for RRT certification as determined by NBRC
  • Be a CRT and have four years of full-time clinical experience in respiratory therapy under the supervision of a licensed medical provider AND possess at least 62 semester hours of college credit in the following courses: chemistry, physics, microbiology, mathematics, and anatomy and physiology
  • Be a CRT and possess a bachelor’s degree in an area other than respiratory care with college credit level courses in chemistry, mathematics, anatomy and physiology, physics, and microbiology. Further, candidates must possess at least two years of full-time clinical experience in respiratory care and at least 62 semester hours of college credit from an accredited college or university

CRT and RRT Certification: What to Know about the Three-Year Eligibility Limit

As of January 1, 2004, new graduates of respiratory care education programs have three years after graduating to complete the examination process for the CRT or RRT credentials.

The NBRC and the CoARC identify the RRT credential as the “standard of excellence” in the profession and recognize their responsibility of ensuring all graduates of CoARC-accredited advanced-level education programs have the opportunity to earn the RRT credential.

The NBRC notes that respiratory therapists who possess the RRT credential are in high demand nationwide and are needed to fill a shortage of qualified respiratory therapists.

The NBRC has approved a three-year time limit as a way to ensure that respiratory therapists who consider themselves “registry eligible” have taken and passed the RRT examination in a reasonable time frame after earning the CRT credential. Respiratory therapists who do not meet the three-year time limit must retake and pass the Therapist Multiple Choice Examination (TMC) with the higher cut score necessary for RRT credentialing.

The Changing Face of Respiratory Therapy Testing and Certification

Beginning January 2015, the NBRC instituted the Therapist Multiple Choice Examination (TMC). The TMC is a new testing structure that combines the old Entry-Level CRT Examination and the written RRT examination into one, comprehensive examination. RRT credential candidates will still be required to complete the Clinical Simulation Examination (CSE). The goal of the TMC is to reduce the number of examinations required to earn the RRT credential. Although the TMC is the new standard for respiratory therapist credentialing, existing CRTs that took the old exam are grandfathered and allowed to retain licensure in the state in which they are currently licensed to practice.

Two states – Ohio and California – implemented new licensing standards that took effect January of 2015. These states now require new respiratory therapists to earn the RRT credential as the minimum credential for meeting state licensing requirements.

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