As I took on the role of editor for Research and Theory for Nursing Practice (RTNP), I expected to become deeply involved in the process of peer review. Less expected was the range and complexity of peer review issues that came to my attention. An experienced author and reviewer, I had encountered and navigated many stick wickets of peer review. My experience, it turns out, was reflective (though limited in scope) of current issues that I now face as an editor. Seeking a broader frame of reference to guide me, I turned to the literature and soon found that I was not alone in this territory. A Medline search of peer review for research surfaced over 500 citations for the past 15 months alone! Obviously, the clarity and consensus I sought was not to be found either quickly or easily. Nonetheless, a few hours of reading and networking with other editors proved informative on a few points about peer review that I want to share with RTNP's audience. Peer review has roots that go longer and deeper than the last half of the 20th century, when it emerged as a standard of scientific publishing. Its current influence stems from the efforts of editors to publish the most meritorious science from among the volume of manuscripts that were overwhelming the limited number of scientific journals of post-World War II times. In an effort to reduce bias and increase candor of reviews, blinding of authors and reviewers to each others' identities became a cardinal feature of the process. Peer review has been elevated nearly to a stanchion of science through extension to the processes of grant funding and academic promotions. Yet, until the 1980s, empirical evidence to support the effectiveness of peer review in strengthening science was lacking. Now, after several decades of research on peer review, consensus exists only regarding the difficulty of measuring its effectiveness (Berger, 2006). Even so, editors and authors alike are keenly aware of its positive impact on shaping science. Although the process has been called into question with recent exposure of fraudulent scientific publications following rigorous peer review, the dissolution of peer review is quite unlikely. Although peer review is here into the foreseeable future, changes are afoot. One noteworthy trend, already in use among some leading medical journals, is unblinding of the process. Such unveiling is taking several forms. In some cases, only the author's identity is unmasked; in others both sides are revealed to one another. In yet a third iteration, authors choose reviewers, albeit from an approved list and with reviews published along with the accepted paper. If blinding serves to reduce bias and increase candor, how can an open review process be an improvement? To illustrate, I convey one example here. In my initial read of one manuscript submitted to RTNP, I found the article to have substantive value-possibly even groundbreaking significance-to the discipline. However, I thought that authors detracted from its value by their somewhat sensational use of a particularly confrontational exemplar, which could elicit a negative review and might even steer some editors toward rejection. Initiating the peer review process, I was challenged in two regards. The article required reviewers who (a) are among the minority well-grounded in the particular philosophical basis of the article and (b) could and would confront constructively and sensitively the author's choice of exemplar. Fortunately, the author provided copies of other related work to help illuminate the review process. …