Maddie had a very challenging night recently. The patient was s/p craniotomy for acute on chronic SDH and had been excavated earlier today around 0900. Unfortunately, on Maddie's shift, the patient had a swift and significant current neurological decline, went into a fib with/RVR, and required intubation for airway protection throughout the night, Maddie kept the provider informed of the condition changes, and advocated for the patients as well as his significant others concerns of “he was not like this today“. It should be noted that the initial provider's response to Maddie‘s multiple concerns was met with inaction, and no orders were received for a sustained heart rate of 150s. However, Maddie was persistent, and she notified another provider to voice her concerns for the patient, which resulted in this physician coming to the bedside to examine the patient (and treat accordingly). As a new nurse, Maddie’s diligence and commitment to providing safe patient care in the situation is quite impressive and deserving of recognition.