RESPIRATORY THERAPIST Source: U.S. Department of Labor Bureau of Labor Statistics
[Occupational Outlook Handbook, 2010-11 edition]
NATURE OF WORK
Respiratory therapists—also known as respiratory care practitioners—evaluate, treat, and care for
patients with breathing or other cardiopulmonary disorders. Practicing under the direction of a
physician, respiratory therapists assume primary responsibility for all respiratory care therapeutic
treatments and diagnostic procedures, including the supervision of respiratory therapy technicians.
They consult with physicians and other healthcare staff to help develop and modify patient care plans.
Therapists also provide complex therapy requiring considerable independent judgment, such as caring
for patients on life support in intensive-care units of hospitals.
Respiratory therapists evaluate and treat all types of patients, ranging from premature infants whose
lungs are not fully developed to elderly people whose lungs are diseased. They provide temporary
relief to patients with chronic asthma or emphysema and give emergency care to patients who are
victims of a heart attack, stroke, drowning, or shock.
Respiratory therapists interview patients, perform limited physical examinations, and conduct
diagnostic tests. For example, respiratory therapists test a patient's breathing capacity and determine
the concentration of oxygen and other gases in a patient's blood. They also measure a patient's pH,
which indicates the acidity or alkalinity of the blood. To evaluate a patient's lung capacity, respiratory
therapists have the patient breathe into an instrument that measures the volume and flow of oxygen
during inhalation and exhalation. By comparing the reading with the norm for the patient's age,
height, weight, and sex, respiratory therapists can provide information that helps determine whether
the patient has any lung deficiencies. To analyze oxygen, carbon dioxide, and blood pH levels,
therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results
to a physician, who then makes treatment decisions.
To treat patients, respiratory therapists use oxygen or oxygen mixtures, chest physiotherapy, and
aerosol medications—liquid medications suspended in a gas that forms a mist which is inhaled.
They teach patients how to inhale the aerosol properly to ensure its effectiveness. When a patient
has difficulty getting enough oxygen into his or her blood, therapists increase the patient's
concentration of oxygen by placing an oxygen mask or nasal cannula on the patient and setting
the oxygen flow at the level prescribed by a physician. Therapists also connect patients who
cannot breathe on their own to ventilators that deliver pressurized oxygen into the lungs. The
therapists insert a tube into the patient's trachea, or windpipe; connect the tube to the ventilator;
and set the rate, volume, and oxygen concentration of the oxygen mixture entering the patient's
lungs.
Therapists perform regular assessments of patients and equipment. If a patient appears to be
having difficulty breathing or if the oxygen, carbon dioxide, or pH level of the blood is abnormal,
therapists change the ventilator setting according to the doctor's orders or check the equipment
for mechanical problems.
Respiratory therapists perform chest physiotherapy on patients to remove mucus from their lungs
and make it easier for them to breathe. Therapists place patients in positions that help drain mucus,
and then vibrate the patients' rib cages, often by tapping on the chest, and tell the patients to cough.
Chest physiotherapy may be needed after surgery, for example, because anesthesia depresses
respiration. As a result, physiotherapy may be prescribed to help get the patient's lungs back to
normal and to prevent congestion. Chest physiotherapy also helps patients suffering from lung
diseases, such as cystic fibrosis, that cause mucus to collect in the lungs.
Therapists who work in home care teach patients and their families to use ventilators and other
life-support systems. In addition, these therapists visit patients in their homes to inspect and
clean equipment, evaluate the home environment, and ensure that patients have sufficient knowledge
of their diseases and the proper use of their medications and equipment. Therapists also make
emergency visits if equipment problems arise.
In some hospitals, therapists perform tasks that fall outside their traditional role. Therapists are
becoming involved in areas such as pulmonary rehabilitation, smoking-cessation counseling,
disease prevention, case management, and polysomnography—the diagnosis of breathing disorders
during sleep, such as apnea. Respiratory therapists also increasingly treat critical-care patients,
either as part of surface and air transport teams or as part of rapid-response teams in hospitals.
WORK ENVIRONMENT
Respiratory therapists generally work between 35 and 40 hours a week. Because
hospitals operate around the clock, therapists can work evenings, nights, or weekends. They spend
long periods standing and walking between patients' rooms. In an emergency, therapists work under
the stress of the situation. Respiratory therapists employed in home healthcare must travel frequently
to patients' homes.
Respiratory therapists are trained to work with gases stored under pressure. Adherence to safety
precautions and regular maintenance and testing of equipment minimize the risk of injury. As in
many other health occupations, respiratory therapists are exposed to infectious diseases, but by
carefully following proper procedures, they can minimize these risks.
TRAINING, OTHER QUALIFICATIONS & ADVANCEMENT
An associate degree is the minimum educational requirement, but a bachelor's or master's degree
may be important for advancement. All States, except Alaska and Hawaii, require respiratory therapists
to be licensed.
EDUCATION & TRAINING
An associate degree is required to become a respiratory therapist. Training
is offered at the postsecondary level by colleges and universities, medical schools, vocational-technica
institutes, and the Armed Forces. Most programs award associate or bachelor's degree and prep
graduates for jobs as advanced respiratory therapists. A limited number of associate degree programs
lead to jobs as entry-level respiratory therapists. According to the Commission on Accreditation of
Allied Health Education Programs (CAAHEP), 31 entry-level and 346 advanced respiratory therapy
programs were accredited in the United States in 2008.
Among the areas of study in respiratory therapy programs are human anatomy and physiology,
pathophysiology, chemistry, physics, microbiology, pharmacology, and mathematics. Other courses
deal with therapeutic and diagnostic procedures and tests, equipment, patient assessment,
cardiopulmonary resuscitation, the application of clinical practice guidelines, patient care outside
of hospitals, cardiac and pulmonary rehabilitation, respiratory health promotion and disease
prevention, and medical recordkeeping and reimbursement.
High school students interested in applying to respiratory therapy programs should take courses
in health, biology, mathematics, chemistry, and physics. Respiratory care involves basic
mathematical problem solving and an understanding of chemical and physical principles.
For example, respiratory care workers must be able to compute dosages of medication and
calculate gas concentrations.
LICENSURE & CERTIFICATION
A license is required to practice as a respiratory therapist, except in
Alaska and Hawaii. Also, most employers require respiratory therapists to maintain a cardiopulmonary
resuscitation (CPR) certification.
Licensure is usually based, in large part, on meeting the requirements for certification from the
National Board for Respiratory Care (NBRC). The board offers the Certified Respiratory Therapist (CRT)
credential to those who graduate from entry-level or advanced programs accredited by CAAHEP or
the Committee on Accreditation for Respiratory Care (CoARC) and who also pass an exam.
The board also awards the Registered Respiratory Therapist (RRT) to CRTs who have graduated
from advanced programs and pass two separate examinations. Supervisory positions and
intensive-care specialties usually require the RRT.
OTHER QUALIFICATIONS
Therapists should be sensitive to a patient's physical and psychological
needs. Respiratory care practitioners must pay attention to detail, follow instructions, and work
as part of a team. In addition, operating advanced equipment requires proficiency with computers.
ADVANCEMENT
Respiratory therapists advance in clinical practice by moving from general care to
the care of critically ill patients who have significant problems in other organ systems, such as
the heart or kidneys. Respiratory therapists, especially those with a bachelor's or master's degree,
also may advance to supervisory or managerial positions in a respiratory therapy department.
Respiratory therapists in home healthcare and equipment rental firms may become branch
managers. Some respiratory therapists advance by moving into teaching positions. Some
others use the knowledge gained as a respiratory therapist to work in another industry, such
as developing, marketing, or selling pharmaceuticals and medical devices.
EMPLOYMENT
Respiratory therapists held about 105,900 jobs in 2008. About 81 percent of jobs were in hospitals,
mainly in departments of respiratory care, anesthesiology, or pulmonary medicine. Most of the
remaining jobs were in offices of physicians or other health practitioners, consumer-goods
rental firms that supply respiratory equipment for home use, nursing care facilities,
employment services, and home healthcare services.
JOB OUTLOOK
Much faster than average growth is projected for respiratory therapists. Job opportunities should be very good.
Employment change. Employment of respiratory therapists is expected to grow by 21 percent from 2008 to 2018,
much faster than the average for all occupations. The increasing demand will come from substantial growth
in the middle-aged and elderly population—a development that will heighten the incidence of cardiopulmonary
disease. Growth in demand also will result from the expanding role of respiratory therapists in case management,
disease prevention, emergency care, and the early detection of pulmonary disorders.
Older Americans suffer most from respiratory ailments and cardiopulmonary diseases, such as pneumonia,
chronic bronchitis, emphysema, and heart disease. As the number of older persons increases, the need for
respiratory therapists is expected to increase as well. In addition, advances in inhalable medications and in
the treatment of lung transplant patients, heart attack and accident victims, and premature infants—many
of whom depend on a ventilator during part of their treatment—will increase the demand for the services of
respiratory care practitioners.
JOB PROSPECTS
Job opportunities are expected to be very good, especially for those with a bachelor’s degree
and certification, and those with cardiopulmonary care skills or experience working with infants. The vast
majority of job openings will continue to be in hospitals. However, a growing number of openings are
expected to be outside of hospitals, especially in home healthcare services, offices of physicians or other
health practitioners, consumer-goods rental firms, or in the employment services industry as a temporary
worker in various settings
EARNINGS
Median annual wages of wage-and-salary respiratory therapists were $52,200 in May 2008. The middle 50
percent earned between $44,490 and $61,720. The lowest 10 percent earned less than $37,920 and the
highest 10 percent earned more than $69,800.
