How to Get Your North Dakota Respiratory Therapist License in 2026

## How to Become a Licensed Respiratory Therapist in North Dakota North Dakota licenses respiratory therapists through the **North Dakota Board of Respiratory Care**, a stand-alone board that enforces the state's Respiratory Care Practice Act. The state's rural and frontier character creates consistent demand for RTs across both major metro centers and critical-access hospitals, making licensure here a direct path to stable, well-compensated employment. ### Step 1: Complete a CoARC-Accredited Respiratory Therapy Program Your first step is graduating from a respiratory therapy program accredited by the **Commission on Accreditation for Respiratory Care (CoARC)**. North Dakota candidates most commonly attend programs at Bismarck State College or travel to neighboring states for CoARC programs, then return to practice. A two-year Associate of Applied Science in Respiratory Therapy is the standard entry point; a Bachelor of Science in Respiratory Therapy (BSRT) is increasingly preferred by hospitals and positions you for leadership and management roles. Your program must include didactic coursework in cardiopulmonary anatomy and physiology, mechanical ventilation, neonatal/pediatric respiratory care, pulmonary function testing, and pharmacology, plus extensive supervised clinical hours across acute, critical, and rehabilitative care settings. ### Step 2: Pass the NBRC Examinations The **National Board for Respiratory Care (NBRC)** administers the credentialing exams that form the backbone of North Dakota licensure: - **TMC (Therapist Multiple Choice) Examination** — 160 questions covering the full scope of entry-level and advanced respiratory practice. A high-cut score on the TMC earns you the **Registered Respiratory Therapist (RRT)** credential directly; a low-cut score leads to the **Certified Respiratory Therapist (CRT)** credential. - **CSE (Clinical Simulation Examination)** — Required for full RRT designation. This 22-scenario exam tests clinical decision-making in complex patient situations. North Dakota requires the **RRT credential** for licensure. CRT alone is not sufficient to obtain or maintain an active ND license. Both exams are administered at Pearson VUE test centers. ### Step 3: Apply for Your North Dakota License Once you hold the RRT credential, submit your application to the North Dakota Board of Respiratory Care: 1. Complete the online application on the Board's website. 2. Pay the licensure fee (approximately **$50–$75**; verify the current amount on the Board's fee schedule). 3. Submit official NBRC credential verification. 4. Provide official transcripts from your CoARC-accredited program. 5. Complete a criminal background check as required by state law. 6. If licensed in another state, submit verification of that license in good standing. Processing times typically run two to four weeks. North Dakota does not yet participate in the RT Compact, so out-of-state practitioners must complete the full application process. ### CRT vs. RRT: Which Do You Need in North Dakota? North Dakota requires the **RRT** credential for licensure — the CRT alone does not meet the state's minimum standard. If you currently hold only the CRT, you must pass the CSE to achieve RRT status before the Board will issue a license. This standard reflects the Board's commitment to ensuring all practicing RTs in the state can manage the full scope of respiratory care, including critical care ventilator management that is especially important in rural hospitals where RTs may be the only credentialed respiratory professional on staff. ### Continuing Education Requirements North Dakota licensed RTs must complete **30 continuing education hours every two years** to renew. Acceptable CE activities include: - AARC-approved seminars, conferences, and online modules - NBRC-sponsored specialty examinations (e.g., CPFT, RPFT, NPS, SDS, ACCS) - College coursework in respiratory care or a related clinical field - Employer-provided in-service training that meets CE standards Keep documentation of all CE activities; the Board conducts audits and may request proof of completion at renewal. License renewal fees typically run in the same range as the initial application fee. ### North Dakota Respiratory Therapist Salary Ranges Compensation for RTs in North Dakota is competitive with regional peers and reflects the demand created by the state's aging population and frontier geography: - **Entry-level RRT (0–2 years):** $52,000–$62,000/year - **Mid-career (3–7 years):** $60,000–$72,000/year - **Senior/Lead RT (8+ years):** $70,000–$82,000/year - **Travel RT contracts in rural ND:** $1,800–$2,400/week (13-week assignments) The **Fargo–Moorhead** metro market typically pays 5–8% more than the statewide average, driven by competition among major health systems. **Bismarck** offers comparable base rates with lower cost of living. ### Top Employers The North Dakota RT job market is anchored by two dominant health systems: - **Sanford Health** — The largest health system in the Dakotas, with a major presence in Fargo and Bismarck. Sanford operates large ICUs and a level II trauma center, creating strong demand for experienced RTs. - **Essentia Health** — Strong presence in Fargo and the Red River Valley region; known for competitive benefits and rural outreach programs. - **CHI St. Alexius Health** — Bismarck's primary tertiary care center and a major RT employer in the western part of the state. - **Critical Access Hospitals** — Dozens of CAHs across rural North Dakota rely on RTs; these positions often come with sign-on bonuses and loan-repayment incentives through federal HPSA programs. North Dakota's combination of NBRC-credential rigor, straightforward licensure pathway, and genuine shortage of qualified RTs in rural areas makes it a strong market for both new graduates and experienced therapists seeking stable employment.