Nurses are at the forefront of recognizing and managing patient situations which may be potentially life-threatening. This study examines the nature and extent to which nursing experience and selected educational variables have on nurses' perceptions of their competence in managing deteriorating patient situations in acute care. Self-awareness of nurses' competence in managing these types of patient situations is critical. Benner's Novice to Expert Model of developmental competency is the

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... tical framework for this study. A survey methodology was used to gather data on the variables: years of experience in nursing, years working in current specialty, educational preparation, national certification, area of specialization, cross-training in more than one specialty, and advanced life support or rapid response team member training. Attendance at a case review session where actual cases were reviewed was also a variable. Instrumentation included an adapted version of the Nurse Competence Scale, a thirteen-item scale related to managing patient situations. Content validity was established by an expert panel of nurses practicing in acute care in the roles of Clinical Nurse Specialist, Nurse Manager, and staff nurses. The setting for the study was an acute care community hospital in the Northeast. Of 212 registered nurses eligible to participate in the survey, the data producing sample of 74 subjects resulted in a 35% return rate. Using SAS, data analysis included univariate descriptive statistics and logistic regression to determine predictive values on nurses' self-perceived competence in managing deteriorating I would like to thank my Chief Nursing Officer, Barbara Seagrave, MSN, RN, NE-BC, for the ongoing support of this study. I am deeply grateful to my family for sharing my commitment to the pursuit of doctoral education. My three brothers, Tom, Mike and Terrence Donilon, and their families, kept me motivated to continue moving ahead, especially at times when the goal seemed far reaching. Their professions are in fields other than healthcare, and I am honored that they are so proud their sister is a nurse. This dissertation is dedicated to the memory of my parents, Edward and Theresa Donilon, whose love, perseverance v and commitment to our family, especially to our education, have enabled and inspired us to pursue our dreams.