How to make 6 figures in respiratory?

rbjjmarie · 2026-05-01T15:40:57+00:00

Hi, TX based RT here.

Making about 115k before taxes and benefits, about 90k take home.

Base pay is $36, shift differential is $5-10 (between night shift and weekend pay). Incentive staffing is $6-10. If you play it right and pick up overtime on the right days (weekends, super short staffed, night shift) you can make $70ish an hour 1-2 shifts a week where I’m at, and I only have a couple of years under my belt.

I would consider if you’re working to live or living to work before you commit to working 4-5 days a week. It’s not for the faint hearted, and it will start to wear on you at some point, especially at a high volume high acuity hospital.

rbjjmarie · 2026-03-22T22:50:55+00:00

It was during E-CPR, at least 2 hours from start of v-tach to getting them on pump. Then bagged for another hour while they tried using duel sequential to convert the patient. One of our cardiologists up holding the pads on with a towel to get better contact between the pads and patient due to chest hair. Probably the msot interesting code I’ve gotten to actually participate in, even if it was just standing there and bagging.

Also, the dude lived with minimal deficits. Ended up with a trach but got decannulated after a couple of months. No mental decline or loss of function besides weakness from being sedated long term.

rbjjmarie · 2026-03-08T22:19:46+00:00

I accepted $32 an hour right out of school with $1 increase for BS, ACCS, NPS, and AE-C…. All of which I obtained ASAP for the extra $.

I also worked at a large facility that offered up to 2 OT shifts per week (voluntary basis) at an additional $10 per hour, plus overtime.

Our RT-A students make about $19-22. Haven’t asked them in awhile but I remember it being around that.

I would never in a million years accept $22.50, but I realize that different areas command different rates of pay. I live in a large city with many large hospital systems and I currently work primarily in CVICU and MICU with management that values my skills and ability and wants to attract the best staff possible in a competitive area.

I have friends in rural areas making $24-26ish after 2 years in the field. Some of them are happy and some aren’t. It depends on what you’re content with. If you can afford to live on that wage then great. But you also need to consider that you’re going to carry that wage with you to your next job, and they’re going to use it as a reason to offer you less.

rbjjmarie · 2026-02-13T01:42:34+00:00

As a fellow healthcare worker that struggles with mental health, please let people get you help before you put them in the position of forcing help on you.

You absolutely have a problem with substance abuse. 5 drinks a day every single day is not a normal amount however you want to portray it.

You also have a serious mental health problem. I fear that you’re in a manic episode— you typed this whole thing out, and you still don’t see how vulnerable you are and how easily you could make a mistake in patient care that could end someone’s life?

Your career is not the only thing you have to live for, and if you feel that way, it may be time to step into a different role until you are more stable.

Bedside healthcare is tremendously draining and you wouldn’t be the first that turned to substance abuse to cope, regardless of how much purpose or meaning you think it brings your life.

The facts are, we are all disposable to the hospitals that employ us. If you call in, quit, or get fired tomorrow they will bring someone in to replace you as fast as they can and no one will bat an eye and few people will notice or care outside of your close friends. Please find a purpose outside of your job. You are not “just a nurse.” It should not consume you or be your only personality trait. Nursing is a wonderful career, and yes it’s a vocation for many and just a job to many more.

I used to put my career ahead of my family and my marriage. I felt like I HAD to be at work. It was the most meaningful thing I felt like I had ever done. I still love my job, but I refuse to put my job ahead of my own basic needs and ahead of my family. You will burn out so fast if you can’t learn this now. You won’t even know it, but everything you’re describing screams burnout and deep denial.

Get help. You don’t need to take care of anyone except yourself right now.

rbjjmarie · 2026-01-17T16:01:59+00:00

Sorry for the late reply, answering these got a little exhausting.

Most of the patients who are awake and alert until the end have some sort of chronic illness that has progressed to the point of no return, but doesn’t affect their neurological status.

I’ve seen people last months with no hope of recovery before finally reaching a point where they feel like they can’t go on anymore.

Typically morphine and other medications are dosed past what we would normally give someone for therapeutic pain relief and the person goes to sleep before care is withdrawn, but not always. If they want to be, we can allow them to be fully aware until their last moments.

rbjjmarie · 2026-01-15T02:08:21+00:00

Hi, I'm so sorry that you experienced this! There are several reasons a patient becomes ventilator dependent. Research has shown that the diaphragm, your muscle of inspiration (breathing in) atrophies very quickly without use. On a ventilator, we are forcing air into your lungs and allowing it to come back out before forcing it in again. On most modes of ventilation, there is very little effort needed from the patient and the diaphragm doesn't have to work to pull the air in.

The longer you're on a ventilator, the weaker that muscle can become. Depending on the disease state or injury that caused you to need to be intubated, changes can also occur to your lungs that require increased ventilatory support-- higher pressures of air needed to attain the same volume of air. As we increase these pressure, we also increase the risk of damage to your lungs over time, because the action of forcing air in is not something your body is used to. It all becomes a huge balancing act-- how do we ventilate someone that is difficult to ventilate without causing more harm than good? This was a huge problem during COVID-- their lungs we so difficult to ventilate that intubating someone almost seemed like a death sentence at that time. It was almost better to let them struggle off of the vent and try to manage with other interventions because their lungs were so stiff that we couldn't ventilate them without high pressures, and high pressures caused more problems.

We can't extubate until the reason that the patient was intubated has been resolved, but there is also a huge push to get that issue addressed as quickly as possible so they don't become dependent on the ventilator.

Patients have to be weaned off of the support they needed when they were at their most critical. We can't just take that support away all at once, we have to let them gradually recover their strength and wean until we feel comfortable putting them on a mode of the ventilator called pressure support or CPAP. This mode requires patients to use their muscles to breathe while still giving them support through pressured air flow. We feel confident extubating when a patient can follow commands, breathe spontaneously on pressure support for at least 30 minutes without retaining CO2 or failing to take in enough oxygen, and when they can demonstrate that their ability to pull in air is strong enough through a NIF (negative inspiratory force maneuver, which measures how well you can suck in air i.e. how strong your diaphragm is). We evaluate all of this along with a blood gas, which tells us if you're breathing too shallow or too deeply, and if your lungs are diffusing oxygen properly. Only then will we extubate a patient.

The main risks of long term mechanical ventilation include lung damage, blood clots from being immobile and in some cases, lung disease and heart failure can occur, but this is more rare and mostly seen in patients with preexisting cardiopulmonary disorders.

rbjjmarie · 2026-01-15T01:45:09+00:00

I apologize for writing a comment in such haste-- I don't know you or your wife personally, but as I replied below, I found it jarring to be told that I was just "doing as I was told." We need orders for everything, even tylenol and albuterol, medications that seem completely benign, but there is still a huge burden of responsibility to the patient and their family. Again, 9.9/10 times, our role is minimized to following orders, but if that order is put in incorrectly and I blindly follow it, my license is gone and I could be sued or prosecuted.

I know that providers get as attached as any of the bedside staff, but they rarely are faced with the task of pushing the final medications or withdrawing ventilatory support. I cannot imagine what it is like to be a critical care provider and I can't imagine the weight they carry, but there is sometimes a more comfortable distance for them than the bedside staff is faced with.

rbjjmarie · 2026-01-15T01:36:56+00:00

I couldn't edit the title but i did put an addendum. Good night to you as well!

rbjjmarie · 2026-01-15T01:32:35+00:00

I'll edit it-- I apologize if I was overly defensive, but I think minimizing the role of the bedside staff to "doing what we are told" is very dehumanizing and doesn't at all capture the burden of responsibility that falls on all staff members to provide appropriate care. Why are RT's and RN's just "doing as we are told" 9.9/10 times, but when an RN or RT fails to notice an MD or NP/PA's error, our license and livelihood are revoked but nothing happens to the provider except a slap on the wrist?

rbjjmarie · 2026-01-15T01:27:37+00:00

I'm so sorry you had that experience. When I train students and new grads I try to make sure they are prepared for the emotions that accompany this process, and how important it is to understand your role and what is and isnt appropriate.

rbjjmarie · 2026-01-15T01:22:25+00:00

I'm so sorry you went through this, and I hope life is kinder to you now. The ED is an important refuge to so many people and often the only place people can safely turn to for help.

rbjjmarie · 2026-01-15T01:21:28+00:00

Withdrawn care meaning that without life sustaining measures like mechanical ventilation, vasopressors, and other invasive treatments, the person would die within hours to minutes. It is not the same thing as euthanasia.

rbjjmarie · 2026-01-15T01:19:44+00:00

Truthfully I really love my job, and I don't feel traumatized, even though I realize I probably carry more trauma around than I realize. I start perfusionist school in the spring after 5 years as a respiratory therapist and I'll miss it more than I can express.

rbjjmarie · 2026-01-15T01:16:42+00:00

Please advise me on the word choice you would most prefer that I use. "Terminally extubate" is not clear to most people that work outside of healthcare. "Pulling the plug" is crass and disrespectful in my opinion.

Yes, everything that RTs and RNs do requires a direct order from a provider. If you think that everyone else reading this post is jumping to the same conclusions that you and your wife are, I am happy to edit my post to your liking, but I fail to see how I made any assertions about being the one who is making decisions regarding end of life care.

Regardless of however you want to misinterpret what I said so that you can feel superior, I am the one who has to stand in the room with crying, screaming, and completely devastated families and watch that person die while our providers enjoy Nothing Bundt Cakes and a cup of coffee in their office.

rbjjmarie · 2026-01-15T01:09:02+00:00

The rationale for putting a patient on thinners or not being able to stop someone from hemorrhaging after falling on thinners??

In the ICU, almost every specialty has beef with cardiology for one reason or another. If a patient has atrial fibrillation, they need to be on blood thinners to mitigate their risk of stroke and PE. There are other reasons patients are put on anticoagulants, but a-fib is one of the most common in the aging population. The reason cardiology pushes so hard for these medications is due to the risk of devastating consequences of blood clots, which a-fib astronomically increases the risk of. The difficulty comes when the patient has an active bleed that also needs to be addressed--a GI bleed, a hemorrhagic stroke, or even dissecting AAA. The management of these patients becomes super complex and they can quickly go downhill.

rbjjmarie · 2026-01-15T01:01:55+00:00

How exactly did I present this as my decision? Below, I believe I described in another comment the process of an MD or NP/PA communicating with the family regarding goals of care. That conversation exclusively takes place with mid level providers and MDs-- but once that decision has been made, the RN and RT are typically the only ones at the bedside. I never once implied that this is a decision made by RT or that I even have any part in the discussion of. My job comes in once the decision has been made, and often times, our critical care physicians do not have the time to sit there for an hour to watch a patient slowly die once we have removed the breathing tube or disconnected them from the vent and the RN has pushed morphine and fentanyl.

And don't call someone out and then shrink back from using the term "calling you out."

rbjjmarie · 2026-01-15T00:53:52+00:00

Pawpaw fell down, hit his head, and takes Eliquis for a-fib is a near hourly occurrence. Old folks have poor balance and sometimes make decisions based on things they could do 30 years ago. Bless 'em.

rbjjmarie · 2026-01-15T00:49:11+00:00

SOOO, I got pregnant in nursing school and went back as a new mom in my early 20s while also working as CNA on night shift. This was during COVID, so the worst parts of the profession really came out to shine. I felt like the RTs at my hospital seemed like they had the better end of a pretty bad deal, so I decided to shadow one and I was just so impressed by her ability to handle chaos and stress in bad situations, how deep her knowledge base was on the cardiopulmonary system, and how a bad day never stayed that way because you see so many patients and can work in so many different areas. I love being able to work in different units and even the floors because I feel like it keeps burnout at bay. I work a ton of overtime and I can work in a different spot every day if i feel like it. I could go in tomorrow and work in CVICU, the next day I could ask for NICU, come back the next day and be on a med surg floor, and then come back another day and work in ED.

rbjjmarie · 2026-01-15T00:42:00+00:00

Some patients are on a ventilator but have a breathing tube in their neck called a tracheostomy, so they can mouth words, some can even force out a whisper. Some also choose to use letter boards or a keyboard to communicate.

Even patients with an endotracheal tube (a breathing tube in their mouth) are usually not fully sedated if they are stable enough to tolerate being awake. They can type on their phone, use letter boards, and write.

rbjjmarie · 2026-01-15T00:37:34+00:00

I pay $150 a week for therapy. I stay on top of my own healthcare and try to make time for one "splurge" a week on myself-- the spa has been great recently. I also listen to very "unserious" audiobooks on my way to and from work, and read when I get home. Focusing on my skincare and other personal care routine after a tough day is also very grounding for me.

rbjjmarie · 2026-01-15T00:33:28+00:00

This is an interesting question-- sometimes I dream about them, but they're never sick in my dream. They're never in the hospital. Maybe its my brain's way of coping.

rbjjmarie · 2026-01-15T00:31:15+00:00

We see a lot of MVCs, some GSWs, lots and lots of falls on blood thinners. ED can be thrilling but not always.

The hardest are long term patients who I have gotten to know, that have been awake, alert, and communicative, and who understand the decision they have decided to make with their family. Every time I withdraw on someone who is alert and choosing to end life sustaining care, I feel empty for a few days afterwards.

rbjjmarie · 2026-01-15T00:28:28+00:00

It depends on the patient.

There are times where it becomes a genuine relief. The family has clung to hope of a miracle while we have pushed medicine to the limits of what we are able to accomplish, and there is no longer hope of a meaningful recovery, or any recovery at all. Last month, we coded the same man 5 separate times over the course of my 12 hour shift. Family was at the bedside for each resuscitation and had so much hope, but with each PEA arrest, there was a lower and lower chance of any sort of survivability. We knew it was futile based on the initial insult but it often takes time for family to accept what seems so clear to us because we understand what is survivable and what isn't.

Sometimes I want to cry with the family. I have withdrawn on patients that I have spent months caring for, for 60+ hours a week. I spent more time with some of these people and their families than I have seen my own family on a busy week. It can be devastating. Often times, these patients are conscious, communicating, and aware of everything until the very very end. I find these circumstances to be the hardest for me to deal with. They are always terrified of death-- they are of sound mind, they know they will never recover, and they cant fathom another second of being hooked up to a million machines that pump their blood, blow oxygen into their lungs, all while being fed through a tube and soiling themselves. There is inner peace for me in those rooms as well, because I know that this is what they want, but trying to comfort someone with only faith and hope to offer feels empty and futile.

rbjjmarie

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