The student was on the med/surg unit at Loma Linda VA hospital. The student is in the 3rd semester of her VN program. She was caring for her patient and recognized a significant change in the patient's respiratory status. The patient had an increased work of breathing, upon further assessment the patient vitals were now abnormal. The student notified the nurse immediately and they began a work-up for probable PE. Upon hearing the medication that would be used in the PE protocols, which included starting heparin, she also made the nurse aware that she noted blood in the patient's urine. Her notification of all of these changes in the patient's status proceeded in allowing the patient to get the proper treatment which was a transfer to the ICU and intubation. The student was able to recognize the changes were significant and acted like a part of the healthcare team so that the patient would be able to get the proper care. This one incident is not a one-off as she works with the nurses well and has shown wonderful growth and is extremely humble.