5 Toughest Challenges for New Respiratory Therapists - And How to Overcome Them

Starting as a New RT? Here’s What You Need to Know

Becoming a new respiratory therapist (RT) is exciting but has unique challenges. Transitioning from RT school to real-world patient care can be overwhelming, especially when facing high-pressure environments, skill gaps, and workplace dynamics.

The good news? You’re not alone, and every RT has been where you are. In this article, I’ll break down the five toughest challenges new RTs face and how to overcome them so you can build confidence and thrive in your career.

1. Information Overload and Decision Fatigue

As a student, you had instructors guiding you through every scenario. In the real world, you’re expected to make quick, critical decisions under pressure. Managing patient care, ventilators, medications, and physician orders simultaneously can feel overwhelming.

How to Overcome It:

✔ Prioritize Learning in Small Steps – Focus on mastering one skill at a time, whether it’s ABG interpretation, ventilator management, or emergency response.
✔ Keep a Quick-Reference Notebook – Jot down key ventilator settings, drug dosages, and protocols for easy access.
✔ Ask Questions & Seek Mentorship – No one expects you to know everything immediately. Find an experienced RT to guide you.

👉 Want to learn how mentorship can accelerate your growth? Please read my article on How Mentoring RT Students Transformed My Career.

2. Building Confidence in Patient Care

One of the biggest struggles for new RTs is imposter syndrome—feeling like you’re not "good enough" compared to experienced colleagues. You might second-guess yourself or hesitate before making clinical decisions.

How to Overcome It:

✔ Remind Yourself: You Earned This Role – You passed your exams, completed clinicals, and got hired. You belong here.
✔ Use the "Pause, Breathe, Act" Method – When nervous, take a deep breath, review the situation, and then take action.
✔ Gain Repetition & Exposure – The more patients you see, the more confident you’ll become.

Pro Tip: Keep a journal of successes & lessons learned. Seeing your progress over time helps build confidence.

3. Managing Stress in High-Pressure Situations

RTs work in fast-paced, high-stakes environments like ICUs and ERs. The pressure of handling emergencies, running codes, and making split-second decisions can affect your mental and emotional health.

How to Overcome It:

✔ Develop a Pre-Shift Routine – A 5-minute mental prep (deep breathing, reviewing priorities) helps you start strong.
✔ Use Stress-Management Techniques – Meditation, exercise, and even simple breathing exercises between patients help reset your mind.
✔ Debrief with Colleagues – Talking through tough cases with coworkers helps process emotions and learn from experiences.

If you’re struggling with work-related stress, seek out RT communities or professional mentors for guidance.

4. Navigating Workplace Dynamics & Team Communication

Hospitals are filled with strong personalities, busy physicians, and varying protocols. As a new RT, you might feel unsure when to speak up, ask for help, or advocate for patients.

How to Overcome It:

✔ Be Professional & Respectful – You’ll work with nurses, doctors, and other RTs. Keep communication clear, direct, and positive.
✔ Speak with Confidence – If you believe a treatment plan should be adjusted, present your reasoning clearly and assertively.
✔ Learn How Each Department Works – Understanding ICU, ER, and general floor workflows will make collaboration smoother.

Pro Tip: Observe how experienced RTs handle difficult conversations. Learning from them will help you become a strong communicator.

5. Mastering Time Management & Shift Organization

Juggling multiple patients, ventilator rounds, documentation, and unexpected emergencies can make your shift feel chaotic. Many new RTs struggle with staying on top of their workload without feeling overwhelmed.

How to Overcome It:

✔ Use a Checklist System – Prioritize critical tasks, then work through secondary responsibilities.
✔ Stay Flexible & Adaptable – Some shifts are unpredictable. Learn to adjust your workflow on the fly while prioritizing patient care.
✔ Use Downtime Wisely – Review patient cases, ask questions, and prep for upcoming responsibilities instead of waiting for tasks to come to you.

Strong time management and adaptability will set you apart as a reliable RT.

Final Thoughts: You Are Stronger Than You Think

Every new RT faces challenges, but the difference between those who struggle and those who thrive is mindset, preparation, and persistence. The first few months may feel overwhelming, but remember—every great RT once stood where you are today.

Next Steps for Your RT Growth:

✔ Join professional RT communities for support.
✔ Find a mentor to help guide you.
✔ Continue learning & developing leadership skills.

👉 What has been the biggest challenge in your RT journey? Drop a comment below!

📩 Want more RT career tips, leadership insights, and mentorship advice? Let’s connect on LinkedIn.

🚀 Explore more RT articles & career growth strategies on my blog here.