Jennifer was still on orientation as a new graduate in the Emergency Department when she had an elderly female patient who presented with chest pain. The patient had a level of dementia and was a little difficult to understand. The patient had chest pain at home, but it had resolved by the time she arrived in the ED. Her initial EKG on arrival was non-diagnostic. During the course of her evaluation, the patient started to have recurrent chest pain. Jennifer alertly obtained a repeat EKG. This showed significant ischemic changes. She recognized the change and brought me the EKG. The patient had medication given with resolution of the pain and normalization of the EKG. Due to the dynamic EKG changes, Jennifer helped recognize that the patient had an unstable acute coronary syndrome. Due to her actions, the patient was taken urgently to the cardiac catheterization lab where she received a stent. Jennifer’s clinical recognition and action was excellent, especially in the setting of being such a new nurse.