What Is Respiratory Nursing? The Ultimate Guide 

According to the Centers for Disease Control and Prevention (CDC), in 2020, chronic lower respiratory diseases were the sixth cause of death in the United States. Furthermore, 5 percent of adults in the US have been diagnosed with pulmonary diseases, and these patients constitute a large proportion of hospital readmissions. Respiratory specialists, including nurses, can play a vital role in reducing readmission rates and improving the quality of life of patients with pulmonary diseases by educating patients and helping them develop self-management skills.

Are you interested in working as a respiratory nurse? Read on to learn all there is to know about this vital nursing specialty: responsibilities, salary, possible certifications, and more!

What Does Respiratory Care Mean in Medical Terms?

The Centers for Medicare and Medicaid Services defines respiratory care as the services prescribed by a physician or a non-physician practitioner (NPP) for the assessment, diagnosis, treatment, management, and monitoring of patients with abnormalities and deficiencies of cardiopulmonary function.

Respiratory care may be provided by nurses, respiratory therapists, physical therapists, and other qualified healthcare staff. This care encompasses all of the following services:

• Application techniques to support ventilation and oxygenation in an acute illness, such as the establishment of an artificial airway, ventilatory therapy, precise delivery of oxygen concentrations, and assistance in the removal of secretions from the pulmonary tree
• Therapeutic use of medicinal gases, pharmacologically active mists and aerosols, and equipment, including resuscitators and ventilators
• Bronchial hygiene therapy, such as deep breathing, coughing exercises, intermittent positive pressure breathing (IPPB), postural drainage, chest percussion/vibration, and nasotracheal/endotracheal suctioning
• Diagnostic tests for evaluation by a physician, including pulmonary function tests (PFTs), spirometry, and blood gas analyses
• Pulmonary rehabilitation techniques, such as exercise conditioning, breathing retraining, and patient education regarding the management of their respiratory problems
• Periodic assessment of the patient for the effectiveness of respiratory therapy services

According to the American Association for Respiratory Care, respiratory care professionals may work in all the following settings: 

• Acute care hospitals
• Emergency departments
• Urgent care settings
• Sleep disorder centers and diagnostic laboratories
• Long-term acute care facilities
• Rehabilitation facilities
• Skilled nursing facilities
• Home health
• Patient transport systems
• Physician offices and clinics
• Convalescent and retirement centers
• Educational institutions
• Medical equipment companies and suppliers
• Wellness centers
• Telehealth providers
• Research
• Insurance companies

What Does RACU Stand For?

The abbreviation RACU stands for respiratory acute care unit. This unit receives respiratory patients from various intensive care units. These patients have impaired lung function, which requires intensive monitoring and treatment, and they may require breathing assistance with a respirator. In addition, some patients need chronic support with a ventilator outside hospitals and may be admitted to this unit to treat acute conditions.

Other abbreviations for respiratory units include RICU, which stands for respiratory intensive care unit. This unit may also be called a pulmonary intensive care unit—although the abbreviation PICU more commonly stands for pediatric intensive care unit.

What Is a Respiratory Unit in a Hospital?

By definition, respiratory units care for patients with various respiratory problems. To offer patients the best possible care, respiratory units are staffed by a multidisciplinary team, including the following professionals:

• Physicians specialized in pulmonology and critical care medicine
• Nurse practitioners specialized in caring for patients with special respiratory needs
• Pulmonary fellows
• Nurses
• Case managers
• Respiratory, physical, and occupational therapists
• Speech-language pathologists
• Pharmacists
• Nutritionists
• Social workers
• Unit maintenance staff

Healthcare teams meet daily to review each patient’s progress and discuss their healthcare plan. The core team members include a physician, a registered nurse or nurse practitioner, a pulmonary fellow, and a respiratory therapist. Nurses are usually the primary contact between patients and the healthcare team, but any team member can meet with the patient and family members upon request.

Many patients in RACUs require the assistance of a respirator. In these cases, the healthcare team will try to wean patients off as soon as possible. Limited time on a respirator is vital for the following reasons:

• Patients are less likely to contract a serious infection.
• They spend less time in the hospital.
• They will be able to start physical therapy and rehabilitation sooner, which can significantly contribute to their mental health.

When patients no longer need a respirator, the healthcare team will continue to manage their needs related to their lung function and critical illness until patients are ready to be transferred to a general ward or rehabilitation hospital. Depending on each patient’s condition, they may remain in a RACU for days or even months. 

Many hospitals don’t have specific respiratory units. Nevertheless, all emergency rooms (ERs) and intensive care units (ICUs) must be prepared to treat patients with respiratory healthcare needs. In fact, approximately 30 percent of patients admitted to an ICU experience respiratory distress.

What Is the Role of a Respiratory Nurse?

Respiratory nurses carry out numerous crucial roles to offer patients with lung diseases holistic care. In collaboration with other healthcare professionals, they provide preventive, acute, and rehabilitative patient care in various settings. Preventive care is often offered to individuals, families, and communities through patient education and smoking cessation programs. 

These respiratory professionals may work in various settings, such as hospitals, extended care centers, private companies, health departments, office practices, and clinics. They may be employed to carry out various roles, including the following:

• Registered nurses
• Clinical nurse specialists
• Nurse practitioners
• Nurse managers
• Supervisors
• Coordinators
• Directors
• Executives
• Nurse educators
• Research nurses 

A respiratory registered nurse cares for and treats patients with various respiratory diseases, including pneumonia, chronic obstructive pulmonary disease (COPD), pulmonary hypertension, asthma, tuberculosis, respiratory oncology, transplantation, sleep disorders, and cystic fibrosis. Aside from monitoring and treating patients, respiratory nurses educate patients and contribute to patients’ ability to self-manage their conditions.

Respiratory Therapist vs. Nurse?

Are you interested in respiratory care and unsure whether you should pursue respiratory therapy or nursing? Although both professionals work with the same populations and there is a significant overlap of responsibilities, the following testimonials from healthcare professionals help illustrate some key differences between the two career paths:

“I am both an Rt and Rn and have worked on various departs and divisions. Depends on what you to do as a nurse, in RTyouare the disease expert respiratory specialist, all of your focus is in that one system with all the accoutrements equipment and specialty training to provide any RT need, nursing is whole body all systems all the time so your knowledge base has to be far greater than that of a single system. That being said however, nursing can choose specific areas to work for example Cath Lab, emergency department, special procedures endoscopy, surgery, so your opportunities for growth and change are a little more vast than that of the respiratory specialty.” Reddit – u/Shot_Elderberry_4324

“Nursing is a little more diverse and has many, many different environments. Salaries can vary but with experience, go much higher than RT because of education and specialization. If you ever wanted to work in hospital admin the majority of the staff in those roles have an RN license to their name...” Reddit – u/knh93014

What Does a Respiratory Nurse Do?

The responsibilities of a respiratory nurse vary depending on the specific role they carry out. Nevertheless, the following clinical duties of a respiratory registered nurse or nurse specialist provide aspiring respiratory nurses with a general idea of what their jobs would be like.

• Providing an individualized approach for assessment, diagnosis, planning, and implementation of care plans
• Maintaining an extensive understanding of the evidence base of the available pharmacological treatments
• Collaborating closely with other members of the healthcare team, especially respiratory therapists, in the development and provision of the pulmonary rehabilitation service
• Ensuring high standards of nursing care
• Assisting with the coordination and development of the non-invasive ventilation service
• Coordinating risk assessment processes and taking relevant action to minimize these risks
• Developing flexible and innovative approaches to care for respiratory patients
• Providing specialist support during in-patient stay and post-discharge support in the form of telephone contact or home visits

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How to Become a Respiratory Nurse and How Long Does It Take?

Respiratory nurses are registered nurses (RNs) or advanced practice registered nurses (APRNs). Becoming an RN takes approximately two years for an associate’s degree in nursing (ADN) or four years for a bachelor’s of science in nursing (BSN). 

Nurses who wish to become APRNs must also complete master’s of science in nursing (MSN) programs, which take an average of two years. Master’s programs usually require BSNs, but RN-to-MSN programs are also available for nurses with ADNs and work experience. In summary, becoming an APRN takes approximately six years, whether nurses complete BSN and MSN programs or ADNs, work experience, and RN-to-MSN programs.

In addition, new respiratory nurses often receive on-the-job training during orientation programs, which can be up to twelve weeks long.

Respiratory Nurse Certification?

There are many training, continuing education, and certification options for nurses offering or interested in providing respiratory care.

The National Board for Respiratory Care offers the following specialty credentials for respiratory healthcare professionals:

• Adult Critical Care Specialist
• Neonatal/Pediatric Specialist
• Sleep Disorders Specialist
• Asthma Educator Specialist (AE-C)

The American Association of Critical-Care Nurses (AACN) offers many certification options for acute care nurses, which are relevant for respiratory nurses:

• Acute/Critical Care Nursing – CCRN (Adult)
• Acute/Critical Care Nursing – CCRN (Pediatric)
• Acute/Critical Care Nursing – CCRN (Neonatal)
• Acute/Critical Care Knowledge Professional – CCRN-K (Adult)
• Acute/Critical Care Knowledge Professional – CCRN-K (Pediatric)
• Acute/Critical Care Knowledge Professional – CCRN-K (Neonatal)
• TeleICU Acute/Critical Care Nursing – CCRN-E (Adult)
• Progressive Care Nursing – PCCN (Adult)
• Progressive Care Knowledge Professional – PCCN-K (Adult)
• Cardiac Medicine
• Cardiac Surgery – CSC (Adult)

Courses and Training Opportunities?

Additional certification options, courses, and training opportunities are available for respiratory nurses.

The American Association for Respiratory Care offers the Pulmonary Disease Educator Course, which provides the pulmonary disease management information that health care providers need to improve long-term pulmonary disease care and improve patient quality of life.

In addition, the American Lung Association offers various training and certification options for professionals providing respiratory care. Facilitator training options include the following:

• A Freedom From Smoking facilitator can lead group smoking cessation clinics.
• A Better Breathers Club facilitator leads support groups for adults with chronic lung disease. 
• Open Airways For Schools facilitators help children learn to manage their asthma. 
• INDEPTH facilitators plan and implement educational programs for students as alternatives to suspension for violation of school tobacco, vaping, or nicotine use policies. 
• Not On Tobacco® (N-O-T) facilitators work with the American Lung Association’s teen smoking and vaping cessation program. 
• A Kickin' Asthma facilitator helps kids ages eleven to sixteen learn asthma self-management techniques through fun and interactive approaches.
• A Breathe Well, Live Well facilitator helps adults better manage their asthma.

Additionally, educator training options include the following:

• The Asthma Educator Institute is a professional education course aimed at helping frontline healthcare professionals provide asthma guidelines-based care to patients and their families. 
• The COPD Educator Course provides comprehensive and practical information that healthcare professionals can use in their work with COPD patients while earning continuing education credits.

The American Lung Association also offers continuing education Spirometry Training for healthcare professionals who administer the spirometry test and for primary care providers who interpret the results to assist with diagnosis and disease management. 

How Much Do Respiratory Nurses Make?

Nurse salaries vary significantly from city to city and, even within the same city, from one work setting to another. Furthermore, average salaries increase significantly with additional education, work experience, and certifications. That said, the average RN salary is $82,750 per year. Most respiratory RNs work in hospitals with an average salary of $80,260 to $85,020 annually. Here are additional settings where respiratory RNs may work and the average salaries at each location: 

• Outpatient care centers: $93,070
• Home health care services: $78,190
• Offices of physicians: $73,860
• Nursing care facilities (skilled nursing facilities): $72,260

Furthermore, RNs who have pursued master’s degrees to become nurse practitioners earn, on average, $118,040 per year. Nurse practitioners working in hospitals make between $122,960 and $131,830 annually. The following are additional settings in which respiratory nurse practitioners may work and the average salaries in each location:

• Home health care services: $133,170
• Outpatient care centers: $129,190
• Offices of physicians: $114,870
• Offices of other health practitioners: $108,890

What Is Pulmonary Nursing Like?

Before choosing a nursing specialty, nurses need to be well-informed about the possible challenges of the career path. According to Jennifer Schlette MSN, RN, here are the top ten reasons why respiratory nursing is hard:

1. Respiratory patients have complex conditions. 
2. Pulmonary nurses witness suffering.
3. Respiratory nurses are exposed to x-rays.
4. Some of the medications that respiratory nurses manage are toxic. 
5. Pulmonary nurses are also exposed to contagious diseases.
6. Respiratory nurses often care for patients with life-threatening conditions, which can be extremely stressful. 
7. RACU patients require around-the-clock care, which means nurses must work nights, weekends, and holidays.
8. The job is physically demanding since nurses often have to lift patients and transport equipment.
9. Respiratory nurses will see blood and mucus frequently and often have to suction patients’ lungs.
10. Pulmonary nurses often care for patients in patients’ homes, which may imply dirty environments or unfriendly pets. 

Why Choose Respiratory Nursing?

Even though the COVID-19 pandemic is largely behind us, the world still faces a global lung health crisis. 

• COPD is responsible for 3.2 million deaths yearly, making it the third leading cause of death worldwide.
• Asthma is one of the most common non-communicable diseases worldwide, affecting 262 million people.
• Lung cancer was responsible for 1.8 million deaths in 2020, comprising one in four cancer deaths worldwide.
• Pneumonia is also a leading cause of death, especially since the onset of the COVID-19 pandemic. It accounts for over 2.4 million deaths each year. Furthermore, pneumonia is the leading cause of death for children under five, excluding the neonatal period.
• Tuberculosis deaths worldwide have also risen for the first time in over a decade because of the COVID-19 pandemic. 

Due to the ever-increasing demand for respiratory care, nurses hoping to do work that is needed and makes a difference should consider respiratory nursing.

What Makes a Good Respiratory Nurse: Tips for New Nurses?

Here is some expert advice from seasoned respiratory nurses for new nurses hoping to enter this nursing specialty: 

“Respiratory therapists know MUCH MUCH MORE than most people give them credit for! And most are more than happy to answer your respiratory questions. So be sure to probe their brains when you are there!” Reddit – u/veryjugs

“For any patient room. If there are oxygen and suctions in the wall make sure they work, you know how to use them and has the necessary supplies…If there are oxygen tanks know how to read the dials and how to transfer a the regulator/valve to a fresh tank. Know where your oxygen supplies are. Always glance on your crash cart or crash basket at the start of shift, it's always when it not there that the patient would decide to code.” Reddit – u/Vex_Detrause

Final Thoughts on Working as a Respiratory Nurse

The COVID-19 pandemic might be largely behind us, but respiratory care is as important as ever. Furthermore, all types of facilities and patients of all ages require this specialized care. 

Do you see yourself in this role? If you are still unsure what nursing job would be ideal for you, try picking up per diem nursing shifts. Nothing beats hands-on experience in different settings and roles to help you choose a career path. 

On the other hand, if you don’t think respiratory care is for you, continue learning about other nursing specialties. The perfect specialty for you is out there!

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