30-60-90 day plan for respiratory therapists
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A new respiratory therapist joins a department where the stakes are immediate: ventilators, airway emergencies, arterial blood gases and patients whose breathing can change in minutes. They may know the equipment from school or another hospital, but this hospital's ventilator models, therapist-driven protocols, order sets and rapid response routine are local, and a gap in any of them shows up at three in the morning. A 30-60-90 day plan for respiratory therapists should get credentials and fit testing done first, sign off competencies with a preceptor on a defined schedule and then move the therapist to a full assignment, including nights and critical care where the role requires it.
This plan is for the respiratory care director, department manager or clinical educator hiring a staff therapist into an acute care hospital. Notes for long-term acute care, home care and pulmonary function labs are at the end. The nursing equivalent is the 30-60-90 day plan for nurses, and the general structure is in the 30-60-90 day plan template for new hires.
Credentials, hospital rules and fit testing
State law sets licensure requirements for respiratory therapists, so verify the license on the state board's lookup. The NBRC awards the Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT) credentials, along with specialty credentials, and hospitals often require one of them. As of October 2026, the federal rules a department manager should know are:
- Hospital conditions of participation. 42 CFR 482.57 applies to hospitals that provide respiratory care. It requires a director of respiratory care services who is a doctor of medicine or osteopathy, adequate numbers of therapists and other personnel who meet qualifications set by the medical staff consistent with state law, written designation of the personnel qualified to perform specific procedures and the supervision required, laboratory requirements for blood gases or other tests run in the unit, and services only under the orders of a qualified, licensed practitioner.
- Respiratory protection. OSHA's 29 CFR 1910.134 requires a medical evaluation before an employee is fit tested or required to use a respirator, and fit testing for tight-fitting respirators before initial use, whenever a different facepiece is used and at least annually after that.
- Bloodborne pathogens. Arterial punctures and airway work carry exposure. 29 CFR 1910.1030 requires training at initial assignment and at least annually, and hepatitis B vaccination made available within 10 working days of initial assignment unless an exception applies.
Accreditation standards, state rules and hospital policy add requirements. Confirm them with the medical director and the hospital's compliance team. This is not legal advice.
The 30-60-90 day plan
30-60-90 day plan — [Name], Respiratory Therapist, [hospital]
Reports to: [department manager] Preceptor: [name]
Start: [date] Credential: [CRT / RRT]
Areas: [floors / ICU / ED / NICU] Shift: [days / nights]
Ventilators: [models] Protocols: [list]
DAYS 1-30 — Orientation and core competencies
Goals:
- License and credential verified; fit test done
- Hospital and department orientation, EHR training
- Work alongside the preceptor on floor therapy,
then ventilator checks in the ICU
- Sign off core competencies: medication delivery,
oxygen devices, airway clearance, ABG sampling,
ventilator setup and checks on each model in use
- Learn every therapist-driven protocol and when to
call the physician
Deliverables by day 30:
- Core competency checklist signed
- Chart audit of the therapist's documentation
Check-in: day 30, with [manager and educator]
DAYS 31-60 — Supervised assignment
Goals:
- Carry a floor assignment with the preceptor nearby
- Manage ventilated patients with review
- Respond to rapid responses and codes alongside an
experienced therapist
- Begin night or weekend shifts if the role requires
Deliverables by day 60:
- Critical care competencies signed
- Protocol adherence reviewed in a chart audit
Check-in: day 60
DAYS 61-90 — Full assignment
Goals:
- Carry the full assignment, including critical care
- Lead airway support at a rapid response with a
senior therapist available
- Take one department task (example: equipment
cleaning log or a protocol education session)
Deliverables by day 90:
- All competencies signed for the assigned areas
- Spot-check audits only
Check-in: day 90 — full reviewWhat to measure
Compare against how past new therapists in the department progressed. The standards below are examples only.
| Measure | Why it matters | Example standard (example only) |
|---|---|---|
| Competencies signed on schedule | Unsigned skills limit the assignment | Core list by day 30, critical care by day 60 |
| Treatments given and documented on time | Missed treatments affect patient care | Late or missed treatments explained on every audit |
| Protocol adherence in chart audits | Protocols decide when therapy changes | Assessment and decision documented per protocol |
| Ventilator checks on the policy interval | Alarms and settings drift unnoticed | Every check present on audited charts |
| Handoff completeness | Most shift problems start at handoff | Preceptor observes a complete handoff |
A filled example
Respiratory therapist: Kevin Tran (invented), RRT, three years in a community hospital, joining a teaching hospital with a large ICU.
Day 30: License and RRT verified, fit test passed with the hospital's respirator model. He had not used one of the two ventilator models in the ICU, so the educator added two supervised shifts on it. The chart audit found good assessments but missing reasons when he held a scheduled treatment.
Day 60: Carried a floor assignment and three ventilated patients with the preceptor nearby. He started nights. The second audit showed the reasons documented and protocol steps followed.
Day 90: Took the full ICU assignment. He led airway support at two rapid responses with a senior therapist present and wrote a one-page guide on the less familiar ventilator for the next new hire.
What "on track" looks like
| Checkpoint | On track | Worth a direct conversation |
|---|---|---|
| Day 30 | Core competencies signed; documentation audit reviewed | Working alone on equipment not yet signed off |
| Day 60 | Critical care competencies signed; protocols followed | Protocol steps skipped under workload |
| Day 90 | Full assignment, including nights if required | Avoiding critical care or emergencies |
Working with nursing and physicians
Respiratory therapists work across every unit, and their decisions depend on nurses noticing changes and physicians accepting protocol recommendations. In the first month, have the new therapist round with the charge nurses on the units they will cover and attend ICU rounds with the preceptor. Ask them to note how each team prefers to be called and what information they expect. The nurse manager plan shows the unit side of the same relationships.
Equipment, cleaning and handoffs
Much of a respiratory department's risk sits in equipment rather than procedures: ventilators that must be cleaned and tracked between patients, circuits and filters changed on the schedule the hospital's policy sets, oxygen and suction set up correctly at every bedside, and portable equipment ready for transport. In the first month, have the new therapist spend a shift with whoever runs equipment processing and walk through how a ventilator is taken out of service, cleaned, tested and returned. Then check that their shift handoffs include the equipment on each patient, any alarms that were adjusted and treatments due in the next few hours, so the next therapist is not finding problems at the bedside.
What the department owes the new therapist
- A named preceptor with protected time for sign-offs.
- A written competency list for each area and equipment model.
- Hands-on time with every ventilator model in use, not only the most common one.
- A clear rule on what they may do alone before each competency is signed.
Common mistakes
| Mistake | Result | Fix |
|---|---|---|
| Short orientation because the hire is experienced | Gaps on local equipment and protocols | Competencies by model and protocol, not by years |
| Nights before critical care sign-off | Unsupported decisions with fewer staff | Nights after the day-60 competencies |
| Fit testing left until a surge | No usable respirator when needed | Medical evaluation and fit test in week one |
| No documentation audit | Missed treatments go unnoticed | Chart audits at day 30 and day 60 |
Adapting the plan
- Neonatal and pediatric units: add the neonatal ventilator and delivery room competencies and extend the precepted period.
- Long-term acute care: focus on weaning protocols and tracheostomy care.
- Home care and pulmonary function labs: replace ventilator sign-offs with equipment setup, patient teaching or testing quality checks.
If you are still hiring, the respiratory therapist screening questions cover critical care experience and judgment, and the Boolean search strings for respiratory therapists help with sourcing.
Questions people ask
What should a new respiratory therapist complete before working alone?
License and credential verification, hospital orientation, a medical evaluation and respirator fit test before using a tight-fitting respirator, and the department's competency checklist for the equipment and procedures on their assignment, signed by a preceptor. Which procedures they may perform and the supervision required should be in writing, as the hospital rules require.
What do Medicare hospital rules say about respiratory care?
Under 42 CFR 482.57, a hospital that provides respiratory care must have a director of respiratory care services who is a doctor of medicine or osteopathy, enough qualified staff, written designation of who may perform specific procedures and the supervision required, and services provided only under the orders of a qualified, licensed practitioner. This is not legal advice.
How often does a respiratory therapist need a fit test?
OSHA's respiratory protection standard requires fit testing for tight-fitting respirators before initial use, whenever a different facepiece is used, and at least annually after that. A medical evaluation is required before the fit test or first use of the respirator.
How do you measure a respiratory therapist's first 90 days?
By competencies signed off on schedule, treatments and ventilator checks documented on time, protocol adherence in chart audits, and safe handoffs. Speed comes after accuracy; compare with how past new therapists in the department progressed.