Recognising patient deterioration is a vital nursing role. Observation based on vital signs and early warning scores are mandatory for all adult patients in acute hospital care and are the first steps in identifying deterioration. However, they rely on users’ understanding of the significance of the results they find and their ability to escalate to senior colleagues if necessary. This article examines the non-technical skills nurses require to recognise and escalate patient deterioration. It explores and analyses the literature on this topic and suggests there is a need for greater focus on situational awareness in nurse training and in healthcare in general, as this is linked to improved patient safety.