Caring for children dying of cancer and families experiencing immense suffering is challenging complex work. Pediatric oncology nurses attend to the physical and emotional needs of children and their families during the illness progression, at the moment of death, and beyond, however, little is known about how they themselves are affected, and how this ultimately influences the care they are able to give. My intent with this philosophical hermeneutic research was to add to our understandings of these effects on pediatric oncology nurses and to translate this understanding into ways to support nurses in this challenging component of their work. Fifteen pediatric oncology registered nurses were interviewed to expand our understanding of this topic. These data were then analyzed according to hermeneutic tradition as guided by the philosophical hermeneutics of Hans-Georg Gadamer. Findings from this research revealed that nurses struggled to navigate the ideals of nursing versus the realities of practice when working with children who may die. This continual shifting of lines and positions called for them to maintain a fine balance between the personal and the professional. This ontological struggle is not absolute; rather, it is premised on a shifting continuum based on a complexity of personal and professional beliefs, experiences, and expectations. There needs to be a reminder that death continues to be an unfortunate constant in the work of these nurses. A reality, that in many ways, society has turned away from and hidden, a reality that has shaped the way death is experienced within pediatric oncology. This common middle ground is what nurses called for in order to be sustained and remain in their work. Research and transformative education that specifically addresses the tension created by insufficient end of life and death education is required for nurses to feel more comfortable and competent within the ontology of death and dying. This necessitates a re-conceptualization of how death is processed in pediatric oncology.