Nurses have a pivotal role in the early identification of patients at risk of deterioration through the taking of patient observations and assessment. This paper presents the findings from an ethnographic qualitative study to discover the practice of recording basic observations of general ward patients and discusses how these observations are used in the assessment of the physical state of the patient. The research is a triangulation method including participatory observation (n = 20) and semi-structured interviews (n = 8) of registered (n = 4) and unregistered (n = 4) nursing staff. Although the research is limited by its exploratory nature and the size of both the interview group and the observational study, the findings suggest that the experience of staff is important in the assessment of patients to detect indicators of patient deterioration. The practice of taking basic observations as a part of assessing patients has changed from being the qualified nurses' role to a role delegated to health care assistant. In addition, there appears to be a reliance on the use of electronic monitoring equipment. The results of the research will be utilised to inform where the practice might be improved.