Adult Critical Care Specialty (ACCS)

The Adult Critical Care Specialty (ACCS) Examination objectively measures the knowledge and skills of respiratory therapists in this specialty area. It goes above and beyond general respiratory care activities to focus specifically on competencies that are unique to adult critical care. Therefore, wearing the RRT-ACCS badge of distinction signals to employers, colleagues and patients that your skills are highly specialized.

The ACCS Examination is available for respiratory care professionals who have proven their dedication to excellence by earning the Registered Respiratory Therapist (RRT) credential. For more information, click or tap on a topic below, or visit our ACCS Exam FAQs.

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Adult Critical Care Specialty
SCORINGADMISSION REQUIREMENTSFree Practice ExamSELF-ASSESSMENTGeneral Exam InfoExam FAQSVOUCHERS
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Scoring

The ACCS Examination contains 170 multiple-choice items (150 scored and 20 pretest). You will be given four hours to complete the ACCS Examination. For specific exam content, refer to the Detailed Content Outline.

ACCS Detailed Content Outline – Effective June 2018-July 31, 2026

ACCS Detailed Content Outline – Effective August 2026

Admission Requirements

You must be a Registered Respiratory Therapist (RRT) for at least one year prior to applying for the ACCS Examination.

Free Practice Exam

A free ACCS practice examination is available so you may familiarize yourself with the content and types of questions that will be included on the credentialing exam. This practice examination has 50 items and is shorter than the actual credentialing exam.

The examination committee and the NBRC Board of Trustees agreed that a practice examination that is only a third as long as the actual exam would expedite the process of creating live exams. The practice examination covers the content domains and cognitive item types in the same proportions as the live examinations and was developed by the same committee as the full exam.

ATTENTION – By accessing this examination, you agree not to reproduce, distribute, disclose, offer for sale, or sell any portion of these copyrighted National Board for Respiratory Care, Inc. materials in any format. Failure to comply with these terms may result in disciplinary action by the National Board for Respiratory Care, Inc. including loss of your credential, losing your ability to retake an examination, and/or legal action related to copyright infringement.

ACCS Free Practice Exam - Effective June 2018-July 31, 2026
ACCS Free Practice Exam - Effective August 2026

Self-Assessment

Anyone planning to take the ACCS Examination can assess how they will perform before actually attempting the examination by taking the official NBRC Self-Assessment Examination (SAE). The feedback from the SAE provides an opportunity to evaluate and remedy less-than-desirable examination performance before taking the credentialing examination. The official SAEs are the only products that provide the respective examination committees’ rationale for the best response to each question.

Official SAEs are only available in web-based format for purchase online through the NBRC’s testing agency, PSI. PSI’s e-store offers all currently available NBRC web-based SAEs for purchase online.

To take an online SAE, you must have:

• A compatible internet browser such as the current version of Internet Explorer, Chrome, Firefox or Safari. Other browsers may not work.
• Cookies and scripting must be enabled.
• Pop-up blocking must be disabled.

After your order is placed, you will receive a confirmation e-mail with specific instructions guiding you through the examination process. The e-mail contains your private password that allows you to receive individualized feedback on your performance. You will have 90 days from the time you receive your confirmation e-mail to complete the examination.

Please note: If you purchase an NBRC SAE, your credit card statement will reflect a purchase from LXR.

ATTENTION – By accessing this examination, you agree not to reproduce, distribute, disclose, offer for sale, or sell any portion of these copyrighted National Board for Respiratory Care, Inc. materials in any format. Failure to comply with these terms may result in disciplinary action by the National Board for Respiratory Care, Inc. including loss of your credential, losing your ability to retake an examination, and/or legal action related to copyright infringement.

Go to Self-Assessment Examinations

General Exam Info: Tools for Candidates

These additional tools are available at no cost to help you prepare for the examination:

  • Candidate Handbook: Information, applications and other forms for all NBRC credentialing examinations
  • ACCS Detailed Content Outline – Effective June 2018-July 31, 2026
  • ACCS Detailed Content Outline – Effective August 2026
  • Practice Examination: An online simulation of the real ACCS Examination experience using identical software.
    • ACCS Free Practice Exam – Effective June 2018-July 31, 2026
    • ACCS Free Practice Exam – Effective August 2026
    • ATTENTION – By accessing this examination, you agree not to reproduce, distribute, disclose, offer for sale, or sell any portion of these copyrighted National Board for Respiratory Care, Inc. materials in any format. Failure to comply with these terms may result in disciplinary action by the National Board for Respiratory Care, Inc. including loss of your credential, losing your ability to retake an examination, and/or legal action related to copyright infringement. To access the practice exam and your results:
      • Log in with your email address – this is the email address where your results will be sent.
      • Use the mouse to select your responses and to proceed through the examination.
      • To obtain your results, you must take the entire examination in one sitting. Your results will not be saved if you exit the examination.
      • When you have completed the examination, click Finish and Display. Your results will be displayed on screen and emailed to the address you provided at login.
      • If you need assistance using the examination software, click on the Help button in the lower portion of the screen once you begin the examination.
      • To take the online practice exam, you will need a compatible internet browser such as the current version of Internet Explorer, Chrome, Firefox or Safari. Other browsers may or may not work. Cookies and scripting must be enabled and pop-up blocking must be disabled.
  • Assessment Centers: A listing of assessment centers where exams are offered nationwide, searchable by state or zip code
  • General FAQs: Information on credentials, fees, credential maintenance and other NBRC information
  • Credential Maintenance Program (CMP) Brochure: Detailed information on the NBRC’s Credential Maintenance Program
  • Submit an Online Application
  • Printable ACCS Examination Application

ACCS Exam FAQs

You must be a Registered Respiratory Therapist (RRT) for at least one year prior to applying for the ACCS Examination.

You may apply online or submit a paper application and fee once you have met the admission requirements.

If applying and paying by credit card online, your application is processed immediately. If mailing your application and fee, your application will be processed within approximately five to seven business days. An email confirmation notice of eligibility will be sent to you, which includes a website and toll-free telephone number for you to contact to schedule an examination appointment.

If your eligibility cannot be confirmed, you will be notified by email of the additional information required to complete your application.

The ACCS Examination costs $300 for new applicants and $250 for reapplicants.

Yes, AARC MEMBERS are eligible for a one-time, $40 discount when applying for the first time for the following NBRC examinations:

– CSE
– PFT
– NPS
– SDS
– ACCS

You must register for the AARC Member Discount through the AARC website at https://www.aarc.org/membership/get-a-discount-on-nbrc-exam/. AARC will send an email after registering for the discount containing instructions about accessing the NBRC’s online examination application. You must begin the application process from the link in the instructions you receive from the AARC by email. The discount must be used at the time you submit your application and payment and will not be retroactively applied.

There are no application deadlines. If you meet the admissions requirements for an examination you may submit your application and fee at any time.

If you don’t receive an email confirmation of eligibility or an incomplete notice within four weeks of submitting your application, contact the NBRC. If your application is not on file, you will be asked to send a replacement application form and fee.

NBRC examinations are administered Monday through Saturday at more than 300 assessment centers across the country (except on nationally recognized holidays). Search for an assessment center near you.

Yes. If you are approved to take an examination and paid the appropriate fee, you may schedule online.

A free ACCS practice examination is available so you may familiarize yourself with the content and types of questions that will be included on the credentialing exam. This practice examination has 50 items and is shorter than the actual credentialing exam.

The examination committee and the NBRC Board of Trustees agreed that a practice examination that is only a third as long as the actual exam would expedite the process of creating live exams. The practice examination covers the content domains and cognitive item types in the same proportions as the live examinations and was developed by the same committee as the full exam.

ATTENTION – By accessing this examination, you agree not to reproduce, distribute, disclose, offer for sale, or sell any portion of these copyrighted National Board for Respiratory Care, Inc. materials in any format. Failure to comply with these terms may result in disciplinary action by the National Board for Respiratory Care, Inc. including loss of your credential, losing your ability to retake an examination, and/or legal action related to copyright infringement.

ACCS Free Practice Exam – Effective June 2018-July 31, 2026

ACCS Free Practice Exam – Effective August 2026

If you are assessing your preparedness for the ACCS Examination and feel you need more guidance than the free practice exam, there is a Self-Assessment Examination (SAE) available for purchase. The ACCS SAE has the same number of questions as the credentialing examination.

ATTENTION – By accessing this examination, you agree not to reproduce, distribute, disclose, offer for sale, or sell any portion of these copyrighted National Board for Respiratory Care, Inc. materials in any format. Failure to comply with these terms may result in disciplinary action by the National Board for Respiratory Care, Inc. including loss of your credential, losing your ability to retake an examination, and/or legal action related to copyright infringement.

The testing time for the ACCS Examination is four hours.

To begin your preparation in an informed and organized manner, you should know what to expect from the actual examination in terms of content areas tested. The detailed content outlines present the specific patient care settings and each of the content areas.  The outlines can be used to get a general impression of the examination, and with closer inspection, can give you specific study direction. For example, you can determine the relative importance of each content area on the examination by reviewing the number of questions in each section.

ACCS Detailed Content Outline – Effective June 2018-July 31, 2026

ACCS Detailed Content Outline – Effective August 2026

You will receive information about your score at the test center after completing the examination.

As indicated in the table below, candidates may attempt the Therapist Multiple-Choice and Clinical Simulation Examinations three times, after which the candidate will be required to wait a minimum of 120 days between any subsequent attempt. For the specialty credentialing examinations, including Pulmonary Function Technology, Neonatal/Pediatric Specialty, Sleep Disorders Specialty, and Adult Critical Care Specialty Examinations, candidates may attempt the exam two times, after which the candidate will be required to wait at least 180 days before sitting for the exam again.

Examination

Initial Attempts Without Waiting

Days Between Each Subsequent Attempt

Therapist Multiple-Choice

3

120

Clinical Simulation

3

120

Pulmonary Function Technology

2

180

Neonatal/Pediatric Specialty

2

180

Sleep Disorders Specialty

2

180

Adult Critical Care Specialty

2

180

As the respiratory profession continues to grow and flourish, we feel this is an important and necessary policy to implement in order to ensure caregiver competency and patient safety for years to come.

When you apply for an examination, your eligibility records are maintained for one year following application regardless of whether or not you schedule an exam. If you don’t actively pursue credentialing, your eligibility records are inactivated after one year. If you are a candidate whose records are inactivated, you must reapply as a new candidate and meet the most current admissions requirements to be eligible for the exam. Please note: if you have passed one of the examinations to earn the RRT Credential (TMC or CSE) and allow your application records to become inactivated, your passing performance will be nullified, so we encourage you to pursue credentialing in a timely manner after applying and receiving a confirmation of eligibility notice.

To support you through the entire process, we are committed to providing appropriate notices to candidates before their application records are inactivated, so we also encourage you to keep your contact information current with the NBRC.

There are two sets of secondary test specifications. One set is for items that will engage you in thinking about ethics of the situation. The other set is defined by patient condition.

Addressing ethics content is important for this examination and credential. As an adult critical care specialist, you will engage in situations that include ethical elements, so part of producing a relevant examination is mirroring those situations. In contrast to a CRT Examination, which should assess whether a therapist is safe and competent to provide general respiratory care, ethical considerations are a part of what it means to be recognized as a specialist. Therefore, we have determined you must have a strong grasp on ethical issues before achieving the ACCS specialty credential.

Because the ACCS Examination is a specialty exam, it is more strongly oriented to clinical situations and less toward the technical elements of respiratory care. Without secondary specifications, we know there is a risk of letting one test form emphasize one type of patient condition too much or differently than another test form. For example, one test form could have five items about patients with congestive heart failure while another form might not include any. Therefore, secondary specifications are critical to aligning examination content with activities of specialists and standardizing test forms among candidates.

We conducted a job analysis study to ensure the examination content would be job-related and based on tasks performed by practitioners in this specialty area. To rate the importance of job tasks, we sent several thousand surveys to individuals who are involved in the delivery of care to patients in adult critical care settings.

In developing our ACCS program, we sought input from a variety of organizations representing adult critical care, and we collaborated with other organizations that have a vested interest in protecting the public and improving care for adult critical care patients. Because of this effort, our ACCS program is well respected and supported by several professional organizations, including the American Association for Respiratory Care (AARC), the American College of Chest Physicians (CHEST), the American Society of Anesthesiologists (ASA) and the American Thoracic Society (ATS).

This specialty examination is unique to the daily tasks you’ll perform as an adult critical care specialist. It goes above and beyond general activities, so you can demonstrate your acquired skill level in this expanding specialty of respiratory care.

Purchase a Voucher

If you are an employer or educator who plans to cover the cost of the NBRC credentialing examinations for candidates, an online prepay option is available for your convenience. Simply follow the link below to purchase a prepaid voucher. Once your payment is made, you will receive an email with voucher codes to distribute to candidates to use as payment when applying for the exam.

Purchase a Payment Voucher Now