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

## How to Become a Licensed Respiratory Therapist in Washington Washington State is one of the stronger West Coast markets for respiratory therapists, anchored by a robust healthcare sector in the Seattle metropolitan area and growing regional health systems in Spokane, Tacoma, and the Tri-Cities. The Washington State Department of Health (DOH) manages RT credentialing, and the process requires the full RRT credential. Here is the complete guide for 2026. ### Step 1: Complete a CoARC-Accredited Respiratory Therapy Program Washington has several CoARC-accredited respiratory therapy programs, including programs at community colleges in the Seattle area and eastern Washington. These programs provide the clinical foundation required for NBRC examination eligibility and Washington State credentialing. Confirm your program's CoARC accreditation at coarc.com before enrolling. Associate degree programs (AAS) are the standard entry-level pathway; Bachelor's programs (BS or BSRT) are available and provide expanded career opportunities — particularly in management, education, and advanced clinical roles in larger Seattle-area health systems. Washington's major health systems are sophisticated employers. UW Medicine, Swedish, and MultiCare operate large ICU and specialty departments where a bachelor's degree and advanced credentials (ACCS, ECMO Specialist) are increasingly expected for senior roles. ### Step 2: Pass the NBRC Examinations Washington State requires the RRT credential for credentialing eligibility. The two-exam pathway is: **Therapist Multiple-Choice (TMC) Examination:** Taken after program graduation, this exam assesses your knowledge of respiratory care across all practice domains. You must achieve the higher "RRT cut score" (not just the CRT cut score) to proceed to the CSE. **Clinical Simulation Examination (CSE):** The CSE presents branching clinical scenarios requiring you to select appropriate assessment, treatment, and management decisions across a range of patient situations. Passing the TMC at the RRT level and passing the CSE together earn you the Registered Respiratory Therapist (RRT) designation from the NBRC. Washington does not issue credentials to CRT-only holders. If you have passed the TMC at the CRT level but not yet taken the CSE, you are not eligible for Washington State credentials. Register and schedule exams at nbrc.org. ### Step 3: Apply for Your Washington State Credential Washington calls its RT authorization a "credential" rather than a license, but it functions the same way — you must hold it to practice in the state. Applications are processed through the Washington State Department of Health's Health Systems Quality Assurance division. **Washington RT credential application requirements:** - Completed online application through the DOH Professions portal (doh.wa.gov) - NBRC primary-source verification of your RRT credential - Official transcripts from your CoARC-accredited program - Credential fee of approximately $100–$175 (confirm current fee on the DOH website, as fee schedules are updated regularly) - Disclosure of any prior disciplinary actions or criminal history Washington's DOH is a high-volume licensing agency and processing times can vary significantly by season — plan for 4–10 weeks. If you are under a hiring deadline, contact DOH early and ask about expedited review options for actively employed clinicians. Washington participates in endorsement processes for out-of-state RTs. Submit your primary-state credential verification alongside your NBRC documentation and fee when applying by endorsement. ### CRT vs. RRT: Which Do You Need in Washington? Washington State requires the **RRT** for credentialing. The DOH does not issue a separate CRT-level state credential. This aligns with Washington's employer standards — virtually all hospital-based RT positions in the state list RRT as a minimum requirement, and specialty roles in critical care, NICU, and ECMO explicitly require additional NBRC specialty credentials on top of the base RRT. The ECMO Specialist credential (a separate board-issued certification) is in particularly high demand in Washington's tertiary care centers. RTs who hold both the RRT and ECMO Specialist designations can command significant wage premiums in Seattle-area hospitals. ### Continuing Education Requirements Washington State RT credentials are renewed on a 2-year cycle. Renewal requires **30 contact hours of continuing education** completed during the preceding credential period. Acceptable CE includes: - AARC-approved and Washington State Society for Respiratory Care (WSSRC)-sponsored programs - Hospital in-service education with documented hours - Online CE from NBRC-recognized providers - Academic coursework in respiratory care or related clinical sciences Washington does not currently mandate specific CE subject areas for RT credential renewal, but state requirements can change with each regulatory cycle. Check the DOH website at the start of each renewal period to confirm current requirements. Failed renewal by the credential expiration date results in a lapse. Lapsed credentials require a reinstatement application and fee plus documentation of CE completion during the lapse period. ### Washington Respiratory Therapist Salary Ranges Washington State offers some of the highest RT salaries on the West Coast, driven primarily by the Seattle metropolitan area's competitive labor market and the high cost of living. **Seattle / King County metro:** - Entry-level RRT: $65,000–$76,000/year - Mid-career staff RT (3–7 years): $72,000–$88,000/year - Senior/specialty RT (ACCS, ECMO, NPS): $85,000–$100,000/year - Travel RT in Seattle market: $2,000–$2,800/week all-in **Tacoma / Pierce County:** - Entry-level RRT: $60,000–$70,000/year - Mid-career RT: $68,000–$80,000/year **Spokane / Eastern Washington:** - Entry-level RRT: $54,000–$64,000/year - Mid-career RT: $62,000–$74,000/year Washington has no state income tax, which meaningfully increases the effective take-home relative to high-tax states with comparable gross salaries. ### Top Employers **UW Medicine (Seattle)** — The University of Washington's academic medical center system is Washington's preeminent RT employer. UW Medical Center operates one of the Pacific Northwest's largest ECMO programs and has significant demand for specialty-credentialed RTs across critical care, pulmonary, and pediatric departments. **Swedish Health Services (Seattle)** — Swedish operates multiple hospital campuses in the Seattle area and is consistently one of the largest non-university RT employers in the region. The First Hill campus includes a Level I trauma center with strong RT staffing. **MultiCare Health System (Tacoma/Auburn/Covington)** — MultiCare is the dominant health system in the South Puget Sound area and employs RTs across its acute care hospitals and specialty programs. The Tacoma General campus is a major adult tertiary care center. **Providence Health & Services (multiple WA locations)** — Providence operates hospitals and health systems across Western Washington including Everett, Olympia, and Centralia, offering RT positions at multiple acuity levels. **Seattle Children's Hospital** — A pediatric tertiary care center and regional ECMO referral center. Seattle Children's is among the most competitive RT employers in the state for NPS- and ECMO-credentialed respiratory therapists.