How to Get Your Respiratory Therapist License in Hawaii (2026)

How to Become a Licensed Respiratory Therapist in Hawaii

Hawaii's healthcare system faces a unique set of geographic challenges, most acute care resources are concentrated on Oahu, while Maui, the Big Island, Kauai, and Molokai rely on smaller community hospitals and air transport for high-acuity cases. Respiratory therapists in Hawaii work in hospital ICUs, NICUs, emergency departments, and home health settings, with military hospitals on Oahu adding a significant federal employment dimension. Here is the complete 2026 licensure guide.

Step 1: Complete an Accredited Respiratory Therapy Program

Hawaii has limited in-state RT education options, Kapiolani Community College on Oahu offers a CoARC-accredited respiratory therapy program. Many Hawaii-practicing RTs complete training on the mainland and then apply for Hawaii licensure by reciprocity.

Your program must be accredited by the Commission on Accreditation for Respiratory Care (CoARC). The standard entry credential is the Associate of Applied Science (AAS) in Respiratory Therapy (two years). Bachelor's programs (BSRT) are available through mainland institutions and are increasingly preferred by Queen's Medical Center and Hawaii Pacific Health for leadership tracks. Given the difficulty of accessing continuing education and specialty training in Hawaii, BSRT preparation before arriving is a significant advantage.

Step 2: Pass the NBRC Examinations

Hawaii requires active credentials from the National Board for Respiratory Care (NBRC).

TMC (Therapist Multiple Choice) Exam

• 160 questions, 3 hours
• Earns the CRT credential
• Fee: approximately $190

CSE (Clinical Simulation Exam)

• 22 simulated cases, 4 hours
• Requires high-cut TMC score
• Earns the RRT credential
• Fee: approximately $200

Hawaii requires the RRT for full licensure. CRT alone is not sufficient for an unrestricted Hawaii RT license.

Step 3: Apply for Your Hawaii License

RT licensure in Hawaii is administered by the Hawaii Medical Board, specifically its Respiratory Therapist section, which operates under the Department of Commerce and Consumer Affairs. Your application includes:

• Completed Hawaii Medical Board RT application
• License fee of approximately $100-$150
• Official NBRC RRT credential verification
• Criminal background check
• Proof of CoARC program completion

Hawaii does not participate in the national RT licensure compact, so mainland-licensed RTs must apply for a Hawaii-specific license. Processing timelines are typically two to six weeks. Apply well in advance of your planned start date given Hawaii's sometimes slower administrative processing.

Continuing Education Requirements

Hawaii requires 20 CE hours every two years for renewal, one of the lower CE requirements in the country, reflecting Hawaii's workforce retention challenges. AARC-approved courses, NBRC specialty exam preparation, employer-sponsored CE, and accredited online programs all qualify. Online CE is particularly important for neighbor island RTs with limited access to in-person conferences.

CRT vs. RRT: Which Do You Need in Hawaii?

Hawaii requires the RRT for full unrestricted licensure. CRT alone is not accepted. Queen's Medical Center, Straub Medical Center, and Tripler Army Medical Center all require RRT credentials for clinical RT positions. The small size of the Hawaii RT workforce also means that RRT holders with specialty credentials (ECMO, neonatal, pulmonary function) are especially sought-after.

Hawaii Respiratory Therapist Salary Ranges

Hawaii RTs earn approximately $62,000-$90,000 per year at staff level, elevated by the state's high cost of living. Positions on Oahu at Queen's Medical Center, Straub, and TAMC pay at the upper end. Neighbor island positions, Maui Health System, Hilo Medical Center, sometimes offer modest cost-of-living differentials. Military RT positions at TAMC offer federal benefits that effectively raise total compensation significantly. Travel RT contracts in Hawaii typically pay $45-$65 per hour all-in, but finding affordable housing to make travel assignments financially attractive requires careful planning.

Top Employers for Respiratory Therapists in Hawaii

• Queen's Medical Center (Honolulu), the largest private hospital in Hawaii and the primary referral center for the state
• Straub Medical Center (Honolulu), part of Hawaii Pacific Health, offering inpatient and outpatient RT services
• Tripler Army Medical Center (TAMC, Honolulu), major military hospital with federal employment benefits and unique ICU/NICU RT roles
• Hawaii Pacific Health (Kapiolani Medical Center for Women and Children), primary NICU and pediatric RT employer on Oahu
• Maui Health System (Maui Memorial Medical Center), serving the neighbor island's largest community
• Hilo Medical Center (Big Island)
• VA Pacific Islands Health Care System (Honolulu)
• Home health and home oxygen providers, serving Hawaii's aging population and home vent patients, with unique logistical challenges on outer islands