I wanted to let you know of a very positive and acknowledgeable experience I had last week with James, RN. Now, I've always felt that James is one of the strongest OR nurses that I have ever worked with in my 10+ years of providing anesthesia, but last week was just a specific example of how experienced and solid he is in the OR. I'll try to condense as much as possible, so to give you the quick/pertinent information, we had just finished a case in the beach chair position and were in the process of both emerging the patient from anesthesia while also preparing to move the patient to the stretcher from the OR table. Physically, my hands were busy with the patient's head while we lowered the patient from an upright position to a supine one, and I realized that my IV had infiltrated. The patient was showing signs of recovering from the anesthetic (breathing spontaneously with weak coughs, trying to open eyes, etc.) but the reversal agent for the administered paralytics had not been given yet. Now, had the patient been younger, more robust, or at least not as chronically ill (she was obese, had asthma/COPD, heart disease, and a difficult intubation), I may have considered extubation without reversal of the rocuronium. However, in this instance, I didn't think that would be safe nor appropriate. I quickly Vocera'd my MDA, who said they were on the way to help place a new PIV. However, James quickly interjected and asked for the supplies. Between calling the anesthesiologist and actually entering the OR, he had already placed the IV and confirmed its patency. The patient was given Sugammadex and safely extubated. There are numerous other instances that I could describe over the past years where when something during a case has gone array, I've looked over and been relieved that James was there to help. His previous experience has kept patients safe before an adverse or dangerous situation could even arise. James is an incredibly gifted, even-keeled nurse that this hospital and OR should be appreciative to employ.