This paper describes an eight-week study tour of psychiatric institutions and related nurse teaching establishments in the USA during September–October 1975, sponsored by the British Commonwealth Nurses War Memorial Fund. The author visited and observed nursing activity in three major types of health care facility: State hospitals. Veterans Administration hospitals and private hospitals. Registered nurse (RN) training in the USA is of a generalist, rather than specialist, nature based on a modular system of education which includes medical, psychiatric, surgical, community and maternity nursing. The writer observed three specific aspects of nursing activity which he felt to be possible subjects for further detailed examination and possible implementation in the United Kingdom. Nurse teaching is carried out in classroom and clinical areas by the same group of teaching staff. This system, in the opinion of the writer, does much to bring together the ideals of nursing theory and reality of nursing practice. Utilization Review is a system designed to ‘assure effective utilization of hospital personnel, facilities and services’ assure effective utilization of hospital personnel, facilities and services'. The Problem-oriented Nursing Care Record is used to prepare an individual treatment plan for patients and to document progress made within the context of the care plan.