I have been involved in emergency medicine for over twenty years and what I witnessed as an emergency department technician recently was nothing short of extraordinary nursing care that requires recognition for Jessica Rutter, RN. Jess and I were caring for a patient that evening, who had presented to the emergency department from a local rehabilitation facility with an isolated complaint of tachycardia. The patient had been in Jess's care for a couple of hours prior to the transition of care for me at the start of my shift. It was noted shortly after the start of my shift, that the patient had depressed the call bell ten times in ten minutes. Each time the call bell was answered by either Jess or I, the patient repeatedly asked for assistance in the utilization of the television feature on the call bell. This patient was very much aware of her surroundings and arrived at the department in her normal state of health, able to engage in conversation and was oriented to all of her surroundings during previous encounters that evening but appeared to have new difficulty with the simple instructions that were given to her about the use of the call bell. Due to the very slight change in her comprehension of how the call bell operates the television, Jess performed a repeat neurological assessment. What Jess found was that the patient remained conscious, alert and oriented to person, place, times of event and was even aware of the Easter Holiday that had just passed a few days ago. The patient demonstrated clear speech, vital signs were all within normal range, and she was able to follow all commands to assess neurological function. Despite the lack of neurological deficits on her exam, Jess contacted the emergency department physician to discuss the subtle change in the patient's condition and suggested diagnostic imaging due to the acute confusion the patient was experiencing in regard to the call bell system. The emergency department physician ordered a CT scan of the patient's head after hearing Jess's concerns. The results showed a large bleed with impending herniation requiring immediate neurosurgical intervention. The patient was dispositioned to the operating room within the hour of the emergency department provider receiving the critical radiologic study.

I truly feel that it was Jess's attention to detail, her unyielding advocacy for the patient, and her collaboration with the healthcare team that gave this patient a chance at a quality life outcome in the future. Jess's ability to pick up on such a small nuance in the patient's cognitive ability, her attention to detail, and persistent advocacy is why I am nominating her for a DAISY Award. Jess did not allow the fact the patient passed all of the neurological assessments with flying colors to waiver in her decision to speak up and advocate for the patient. What impressed me the most was her ability to stay true to her "gut feeling" or true nurse's intuition, that something was awry with this patient. Jess's attention to detail may have been what saved this patient's life. Witnessing her dedication to figuring out what was going on with her patient was truly a beautiful experience to not only witness but also to be an active participant.

Thank you, Jess, for your dedication and perseverance in patient care. It's an honor to have you as my co-worker.