Respiratory therapist vs registered nurse

Respiratory therapist vs registered nurse is a comparison that students weighing two hospital careers and deans planning allied health and nursing capacity both make. The two roles share hospitals, patients and shift work, but they differ in education, entry examination, regulation and scope. This article sets them side by side for the United States and Canada, using the US Bureau of Labor Statistics, the National Board for Respiratory Care, the Canadian Society of Respiratory Therapists and Job Bank Canada.

Two roles, two scopes

The Bureau of Labor Statistics describes respiratory therapists as clinicians who care for patients with breathing problems such as asthma or chronic obstructive pulmonary disease. Their duties include interviewing and examining patients with cardiopulmonary disorders, performing diagnostic tests such as pulmonary function tests, treating patients and monitoring their progress, operating ventilators and other life-support equipment, and teaching patients and families how to use medications and equipment.

Registered nurses have a much wider remit. The same handbook places them across hospitals, ambulatory services such as physicians' offices and home health, nursing and residential care facilities, government and schools.

Education pathway and length

In the United States, the Bureau of Labor Statistics lists an associate's degree in respiratory therapy from an accredited program as the typical entry-level education, noting that some employers prefer a bachelor's degree. For registered nurses it lists a bachelor's degree, and licensure requires graduating from an approved nursing program and passing a qualifying exam.

In Canada, respiratory therapy programs must be accredited through Accreditation Canada, according to the Canadian Society of Respiratory Therapists, and graduates sit a national certification examination. A step-by-step Canadian account is in how to become a respiratory therapist in canada.

Entry examinations

The National Board for Respiratory Care has announced that, from January 2027, a single multiple-choice Respiratory Therapy Examination will be implemented. It has 185 items, of which 160 are scored and 25 are pretest, and a four-hour time limit. It is assembled in two sections, one for breadth of knowledge and one for depth of clinical judgment. Two cut scores determine the credential: reaching the low cut score earns the Certified Respiratory Therapist credential, and reaching the high cut score earns the Registered Respiratory Therapist credential.

The Clinical Simulation Examination is being eliminated. It remains available through December 31, 2027 for candidates who passed the Therapist Multiple-Choice Examination at the high cut score before December 31, 2026.

In Canada, the Canadian Board for Respiratory Care, now operating as Health Professionals Testing Canada, administers the National Certification Examination in respiratory therapy. The Canadian Society of Respiratory Therapists reports that it is offered twice a year, in January and July. Canadian graduates must complete an accredited program and make a first attempt within 18 months of graduation.

For nursing, the National Council of State Boards of Nursing administers the NCLEX, which it describes as a licensure exam delivered by computerized adaptive testing. In Canada, the College of Nurses of Ontario requires registered nurse applicants to pass the NCLEX-RN, which is administered by Pearson Professional Assessments, with NCSBN as the exam service provider.

Regulation and licensure

Both professions are regulated, but through different bodies. In the United States, the Bureau of Labor Statistics states that respiratory therapists are licensed in all states except Alaska, where national certification is recommended. Registered nurses must hold a license issued by the state where they work.

In Canada, regulation is provincial. In Ontario, the College of Respiratory Therapists of Ontario regulates the profession, setting requirements for entry to practice and standards of practice. In Alberta, the Government of Alberta occupational profile names the College of Respiratory Therapists of Alberta as the regulator and lists completion of an approved education program and an approved examination as requirements. Registered nurses are regulated by separate colleges: the College of Registered Nurses of Alberta describes itself as the regulatory body for registered nurses and nurse practitioners in Alberta, and the College of Nurses of Ontario performs that role in Ontario.

Employment, outlook and pay

The Bureau of Labor Statistics reports about 142,000 respiratory therapist jobs in 2025, with hospitals employing the largest share at about 80%. It projects growth of 9% from 2025 to 2035, an increase of 12,100 jobs. For registered nurses it reports 3,465,400 jobs in 2025, with 59% in hospitals, and projects 6% growth, a net change of 194,700 jobs.

Nurses are roughly 24 times as numerous as respiratory therapists in the US data (derived: 3,465,400 divided by 142,000 is about 24.4), so a small absolute change in respiratory therapy demand can require a proportionally large change in program seats.

For Canada, Job Bank reports a national median hourly wage of $41.00 for respiratory therapists, with a low of $30.16 and a high of $51.00, updated November 19, 2025. For registered nurses (NOC 31301), Job Bank reports a national median of $43.27 per hour, with a low of $30.00 and a high of $54.37, updated the same day.

Side-by-side comparison

Choosing between them

For a student, the decision usually turns on interest rather than pay. Respiratory therapy suits people drawn to physiology, ventilation and acute cardiopulmonary care, and it offers a shorter typical US education.

For a dean or program director, the useful questions are local: how many respiratory therapy graduates the regional hospitals absorb, whether placement sites are limited to a few departments, and how the changing national exam format affects curriculum timing for the 2027 cohorts. Jurisdiction rules differ, so the free licensure map at the licensure map lists requirements for 57 roles across 64 jurisdictions.

Where practice tools fit

ngnsimulation builds unscripted AI patient encounters inside an EHR-style chart, including spoken OSCE practice, adaptive study and quizzing with a placement check, and faculty-facing competency analytics. It runs alongside an existing LMS. Programs can review the options at the demo and the pilot process.