Maddy had a very challenging night. The patient was s/p craniotomy for acute on chronic SDH and had been extubated earlier in the day around 0900. Unfortunately, on Maddy's shift, the patient had swift and significant neurological decline, went into a-fib w/RVR, and required intubation for airway protection. Throughout the night, Maddy kept the provider informed of the condition changes, and advocated for the patient as well as his significant other's concerns of "he was NOT like this today." It should be noted that initial provider's response to Maddy's multiple concerns were met inaction, and no orders were received for sustained heart rate of 150's. However, Maddy was persistent, and she notified another providers to voice her concerns for the patient (and treat accordingly). As a new nurse, Maddy's diligence and commitment to provide safe patient care in this situation is quite impressive and is deserving of recognition.