A patient presented to the RDHW Emergency Department at 3 AM with chest pain. Taylor Gately was the assigned primary nurse. She was precepting a new RN, the department was full, and the team was task-saturated. Initial patient tests were negative for myocardial infarction. Taylor actively monitored her patient for changes and completed several follow up assessments. After three hours, the patient reported that he felt his pain had changed. Taylor and her team completed a fourth EKG, and a STEMI was identified. Under challenging conditions, Taylor followed sound emergency nursing practice that led to the patient being transferred to receive heart-saving interventions. Her actions exemplify the Riverside Care Difference.