Description/Overview: Clinical deterioration frequently goes unnoticed in hospitalized patients (1). Growing concerns about failure-to-rescue rates have prompted government initiatives and consensus statements designed to improve timely recognition of acutely ill patients in hospital (2, 3, 4). Given that detectable physiological signs often precede deterioration (5), hospitals have implemented early warning systems and rapid response teams to identify and respond to patients at risk of clinical deterioration. Yet, there is insufficient evidence about the effectiveness of these interventions (5, 6). These hospital safety initiatives depend on registered nurses’ (RNs) ability to detect patients at risk of clinical deterioration through attentive surveillance, a process which includes ongoing observation and assessment, recognition, interpretation of clinical data, and decision-making (7). The reasons for nurses failing to recognize and respond to clinical deterioration are complex (8), but a key finding is that nurses tend to rely on intuitive judgement rather than physiological signs and physical assessment of the patient (9). Reasons for this are unclear and the factors influencing nurses’ assessment practices are an understudied area. This symposium brings together studies from a program of research designed to build knowledge about improvement of patient assessment for timely detection and management of clinical deterioration. Based on these findings we argue that the current hospital safety agenda and body of research on patient deterioration has redirected nursing practice towards collection and reporting of minimal data to detect end stages of clinical deterioration. This has important implications for patient care, as well as the professional autonomy and role of acute care nurses. The symposium will conclude with facilitated discussion on future directions for research and strategies that support nurses’ timely recognition of patient deterioration.