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Role standards

Therapy and rehabilitation

Respiratory therapist

What a respiratory therapist must be able to do safely at the bedside without supervision: ventilate and oxygenate a sick patient, keep the airway open, find the fault when the equipment or the patient changes, and act in an emergency, drawn from the NBRC Therapist Multiple-Choice Examination that US credentialing uses to make that decision.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
1

Built from National Board for Respiratory Care. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent respiratory therapist does on day one, dimension by dimension.

Clinical skills

  • Sets and adjusts mechanical ventilation from the patient's physiology - predicted body weight, pressures, gases and synchrony - and recommends changes before the patient is harmed by the current settings.
  • Interprets arterial blood gases, pulse oximetry, capnography and chest imaging findings against the patient in front of them, and questions a result that does not fit.

Workflow and tools

  • Finds the cause when a ventilator, oxygen system or monitor alarms, separating a patient problem from an equipment one, and protects the patient first.
  • Records settings, measurements, assessments and changes accurately and at the time, including what was done in an emergency and why.

Patient communication

  • Confirms that a patient can use their inhaler, oxygen or airway device correctly by watching them do it and hearing it back, and re-teaches what went wrong differently.
  • Explains a respiratory condition, device or plan in words the patient can use, including when to seek help.

Compliance and safety

  • Keeps an artificial airway in the right place, patent and secure, confirms placement objectively, and acts at once when it is displaced or blocked.
  • Recognises a patient failing on oxygen or non-invasive support early, and escalates the level of care before the patient arrests.

Role knowledge

  • Takes the airway and ventilation role in a resuscitation or rapid response, delivers high-quality ventilation, and communicates in closed loops with the team.
  • Recommends changes to the respiratory care plan to the responsible provider with the evidence behind them, and follows protocols the team has agreed.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Leaves a patient with lung injury on a tidal volume set from actual body weight or well above eight millilitres per kilogram of predicted body weight, or with a plateau pressure above thirty, and neither changes it within protocol nor raises it with the provider.

    Excess volume and pressure injure the lung further, and lung-protective ventilation is one of the few interventions in ARDS shown to reduce death.

  • Accepts an endotracheal tube as correctly placed on breath sounds, chest rise or tube misting alone, or treats a lost capnography waveform as a monitor fault, without confirming placement with waveform capnography and acting on its absence.

    An unrecognised oesophageal or dislodged tube leaves the patient with no ventilation at all, and the harm is complete within minutes.

  • Silences or turns off a ventilator alarm, or changes the settings to stop it, without finding the cause at the bedside, or keeps a distressed patient on the ventilator without disconnecting and hand-ventilating when the cause is not immediately found.

    The alarm is often the only warning of a blocked tube, a pneumothorax or a disconnection, and a patient who is not being ventilated dies while the machine is investigated.

  • During CPR, ventilates at a fast rate or with large breaths, or stops compressions to deliver breaths after an advanced airway is in place.

    Hyperventilation raises intrathoracic pressure and cuts venous return and coronary perfusion, and pauses in compressions reduce the chance of survival.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not intubate, or change ventilator settings outside an order or an approved therapist-driven protocol, unless facility credentialing and state law grant it.Recommends the change to the responsible provider with the findings, and calls the credentialed airway provider while keeping the patient oxygenated.
  • Does not administer sedatives, paralytics or other medications that are not ordered or are outside state scope and facility policy.Recommends the medication to the prescriber and administers only what is ordered within scope.
  • Does not blindly reinsert a recently formed tracheostomy, usually within about the first week, unless specifically trained and the facility plan allows it.Oxygenates from above and at the stoma, calls the airway team, and follows the emergency tracheostomy algorithm.
  • Does not decide to withhold or withdraw ventilatory support.Carries out withdrawal only on the physician's order after a goals-of-care decision, and makes sure the patient is comfortable.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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