On a very busy overnight shift, Shane Zurbach was caring for a COPD patient. Despite the patient’s oxygen saturation being good, Shane was unsettled by subtle mental status changes he was observing early in the morning hours. As the overnight physician, my initial impression was potential sundowning/ early delirium as the patient was in his late 70s and a couple of days into his hospital stay. Shane and I discussed the case in detail at the bedside, and Shane strongly advocated for further investigation with ABG testing. The ABG showed respiratory acidosis with high CO2 levels. We promptly placed the patient on BIPAP support. After a short time, the patient would decline from a respiratory standpoint, and Shane alerted the rest of the medical team for a rapid response. The patient was transferred to the ICU, where he was emergently intubated. Shane did all this while caring for several other patients that evening. He trusted his nursing instinct and was very in tune with the clinical subtleties of his patient. His compassionate, focused care and strong clinical instinct exemplified the DAISY Award ideals. He truly made a difference in this patient’s care and will continue to do so moving forward.