Delirium is a prevalent, costly, and global problem in older adults. This article is a systematic review of the literature on nurse recognition of delirium. Ten articles, reporting rates of nurse recognition ranging from 26% to 83%, were included in the review. The most compelling finding is that although related, the notions of nurse knowledge of delirium, nurse recognition of delirium, and nurses' assessment and documentation of delirium in older adults are different. Recommendations for practice are suggested at several levels, including education, guidelines, communication, health care system, and use of informatics.