Caring for children with Progressive Life Shortening Illnesses (PLSIs) in pediatric acute care is both rewarding and challenging for nurses. Despite the significant number of pediatric nurses who care for children with PLSIs and their families on general acute care units, little is known about the benefits and difficulties these nurses experience through their work. The intent of this hermeneutic study is to further understanding regarding the experiences of pediatric nurses in this context and to offer ways of better supporting them in their valuable work. Eight nurses from a general pediatric acute care unit were interviewed for this study. These data were analyzed according to the tradition of philosophical hermeneutics as described by Hans-Georg Gadamer. Findings from this research revealed nurses’ struggles to care for children with PLSIs whose lives are shrouded with uncertainty in a death-denying culture that values cure and treatment. Nurses recognized the many rewards and the beauty of their work even though they come to carry a burden and hold a great deal of darkness from the difficulty of what they see and do in their practice. Nurses’ struggles also included caring for children with PLSIs when they are excluded from the decision-making table. Nurses acknowledged that their ability to work in this area was limited as they were aware that the challenges of the work would eventually outweigh the beauty and the benefits. For their survival, nurses learned to depend on each other for support and learned from each other what it means to be a nurse in this area. The implications of this research include facilitating bedside nurses to be present at decision-making meetings and the encouragement and facilitation of nurse-to-nurse support.