What Is A RRT-NPS?

The Short Answer: What an RRT-NPS Actually Is

An RRT-NPS is a respiratory therapist who holds two things: the Registered Respiratory Therapist (RRT) credential and the Neonatal/Pediatric Specialty credential from the National Board for Respiratory Care (NBRC). The "NPS" portion is earned by passing the NBRC Neonatal/Pediatric Specialty Examination, a separate test taken after the RRT is already in hand.

In practical terms, the credential signals advanced competence in caring for critically ill and respiratory-compromised newborns, infants, and children. It documents mastery of areas such as neonatal and pediatric ventilation, airway management, specialty gases, resuscitation, and the family-centered communication that comes with caring for the youngest patients.

If you are new to the terminology, our companion articles on what RRT-NPS is and the RRT-NPS meaning cover the vocabulary in short form. This article goes further into how the credential is earned, what it tests, and what it means for your career.

Decoding the Letters

The designation is a stack of two credentials written together:

• RRT stands for Registered Respiratory Therapist, the NBRC's advanced-level respiratory therapy credential and the prerequisite for the specialty exam.
• NPS stands for Neonatal/Pediatric Specialist, the specialty credential awarded after passing the Neonatal/Pediatric Specialty Examination.

For a deeper treatment of the abbreviation itself, see what RRT-NPS stands for and what RRT-NPS means. The key point is that the specialty does not replace your RRT. It is added to it, and both credentials appear after your name.

Who Issues the Credential and How It Is Earned

The NBRC issues and administers the credential. The route is sequential:

1. Earn the NBRC RRT credential.
2. Apply for the Neonatal/Pediatric Specialty Examination through the NBRC.
3. Sit the exam at a PSI testing center.
4. Receive the NPS credential on passing.

Notably, the NBRC's admission policy for the NPS does not add a specified NICU employment duration, a separate training-hour minimum, or a reference requirement beyond holding the RRT. That matters for newly credentialed RRTs who wonder whether they must log a set number of neonatal hours before applying. The published policy does not require it, though clinical exposure to neonatal and pediatric patients will obviously make the exam far more manageable. Our RRT-NPS requirements guide walks through eligibility in more detail, and the RRT-NPS certification overview places the credential in context.

What the NPS Examination Tests

The current content outline, effective October 1, 2025, organizes the exam into two domains. The NBRC assigns scored items to each rather than printing percentages, so the item counts below are the official allocation.

Across both domains, cases span neonatal and pediatric pulmonary and non-pulmonary disorders as well as general care. Because 30 of the 150 scored items sit in the ventilation and oxygenation subsection, that is where candidates should expect to be pushed hardest: interpreting blood gases, adjusting ventilator parameters for a changing patient, choosing between modes, and recognizing when a patient is failing a strategy. Our exam domains guide breaks each content area down further.

Exam Format and Testing Logistics

Two logistics points deserve emphasis. First, remote proctoring is no longer an option. The NBRC discontinued live remote proctoring after December 31, 2024, and since January 1, 2025 the exam has been delivered at PSI testing centers. Any study resource or forum post that tells you to test from home is out of date. Second, because the 20 pretest items are unidentified, you cannot tell which questions count, so treat every item seriously. For scheduling mechanics, see our exam dates and scheduling guide.

The NBRC scores the exam as a raw count of correct answers compared against a cut score derived from an expert panel. A current numeric NPS cut score was not verified in the NBRC's public materials, so beware of any source that quotes a fixed percentage. Our passing score article explains how to think about this without relying on invented thresholds.

Eligibility, Application, and Fees

Once you hold the RRT, the application is straightforward. The fee structure is:

• First application: $250
• Reapplication: $220
• AARC member discount: qualifying AARC members can receive a one-time $40 discount on the first application through the prescribed AARC registration and email-link process, bringing the first attempt to $210

That discount is not a universal membership perk. It applies only when you follow the specified process, and it is not applied retroactively, so do not pay the full fee first and expect a refund. The NBRC also offers a free official practice examination and a paid self-assessment; these are preparation tools, not additional mandatory qualifying exams.

On retakes, candidates may make two initial attempts without the subsequent-attempt waiting restriction. After that, later attempts require 180 days between tests. For the complete financial picture, including preparation and maintenance costs, see the certification cost breakdown.

What the Pass Data Shows

The NBRC's 2025 Examinations in Review reports that 1,712 NPS examinations were administered and 961 credentials awarded that year. The new-candidate pass rate was 63.4%, while the repeat-candidate rate was 40.4%.

Two cautions apply. The 2025 rates span the October blueprint transition, so they are not exclusively outcomes for the current version of the exam. And the cumulative 21,002 credentials awarded through December 31, 2025 are historical awards, not a count of currently active practitioners. For interpretation, read our pass rate analysis and difficulty guide.

NPS Versus ACCS: Choosing a Specialty

RRTs often weigh the Neonatal/Pediatric Specialty against the NBRC's Adult Critical Care Specialty. The deciding factor is patient population.

Choose based on where you want to practice, not on assumptions about pay. No credential-specific salary uplift was established in the research behind this article, and general respiratory therapist pay differs from any employer-specific incentive for holding a specialty. If compensation drives your decision, our salary guide and ROI analysis separate verified information from speculation.

Where RRT-NPS Therapists Work

The credential fits environments where respiratory care for young patients is central:

• Neonatal intensive care units, including those with high-acuity ventilation and delivery-room resuscitation duties
• Pediatric intensive care units
• Children's hospitals and general pediatric units
• Transport teams moving critically ill newborns and children between facilities
• Other settings that serve pediatric patients with chronic respiratory conditions

Employers may prefer or reward the credential, but incentives vary by organization. Our RRT-NPS jobs article covers hiring patterns, and the training guide discusses how clinical exposure supports exam readiness.

Keeping the Credential Active

The NPS credential is valid for five years from the end of the month it was issued. Maintenance runs through the NBRC Credential Maintenance Program (CMP), and the current brochure was revised October 7, 2026. There are three alternative routes, and you only need one:

1. Assessment and continuing education compliance
2. Retaking the highest applicable credential examination in the last year of your term
3. Earning a new NBRC credential

Under the assessment route, your assessment performance sets how much CE documentation you owe: 0, 15, or 30 credits. For an RT with one specialty, the current chart splits the 30-credit requirement into 15 general respiratory and 15 specialty credits, or the 15-credit requirement into 7.5 general and 7.5 specialty. Other credential combinations are allocated differently, so check the NBRC's chart for your situation.

CMP annual fees are $25 for payment years before 2027 and $30 from payment year 2027. A five-year term entirely at the higher rate totals $150. Choosing examination-based renewal instead requires the relevant exam fee. State licensure renewal is a separate obligation entirely.

Sequencing Your Preparation by Domain

Because Domain 1 holds 80 scored items and Domain 2 holds 70, with ventilation and oxygenation alone worth 30, a sensible plan front-loads the broad shared competencies and then concentrates on critical-care reasoning.

Practice products vary in question counts and timers, so do not treat any third-party format as a stand-in for the real 170-question, four-hour exam. Build stamina against the actual structure. Our study guide expands this plan, and the cheat sheet condenses the must-know facts for last-minute review. When you are ready to test yourself, try the RRT-NPS practice tests to find weak domains, and return to the main practice site for case-based questions modeled on the exam's reasoning style.

Frequently Asked Questions

For a broader view of the credential, revisit the RRT-NPS certification explainer and the related definition article.