I would like to nominate this nurse for recognition as an extraordinary nurse. Their swift assessment, clinical judgment, and calm, decisive action were instrumental in escalating care for a patient in respiratory distress. During their shift, this nurse noted that the patient was exhibiting signs of increased work of breathing. Although the patient was on room air with an oxygen saturation of 98%, and appeared hemodynamically stable with a GCS of 14-15, this nurse recognized that the use of accessory muscles and ineffective coughing were concerning. Breath sounds were coarse bilaterally, and the patient had a recent history of hypoxic arrest due to aspiration of tube feeds, with enteral feeds having been held overnight due to high residuals. Despite the patient’s stable oxygenation, this nurse’s astute clinical assessment prompted them to promptly notify the provider. Upon arrival at the bedside, the provider confirmed the patient’s moderate respiratory distress and initiated interventions. The patient was placed on a high-flow nasal cannula and transferred to the ICU. Within an hour of transfer, the patient became hypotensive and bradycardic, requiring intubation. Thanks to this nurse’s vigilance, rapid action, and collaboration with the care team, the patient received timely escalation to a higher level of care. This nurse remained calm under pressure, carried out all orders efficiently, and provided crucial support to the provider throughout the process. What makes this moment truly exceptional is that, although the patient appeared stable on paper- reassuring SpO2 and ABG values- this nurse did not dismiss the clinical signs they observed. This nurse’s attention to detail and commitment to patient safety played a key role in preventing further deterioration.