The aim of this phenomenological study is to elicit nurses’ experiences of ethical decision-making in caring for patients at the end of life in the acute hospital setting. The objectives are to establish ethical situations which nurses encounter in the day to day care of patients with advanced disease; to explore the role of the nurse in ethical decision making; to examine the factors which influence ethical decision making and to enhance nurses’ ethical decision-making making skills for future practice. There is consensus in the literature that ethical decision-making is part of everyday nursing practice. The literature review highlights the dearth of literature, which focuses on researching ethical decision-making from the nurses’ perspective outside critical and intensive care units. In this study, phenomenology based on the teachings of Heidegger and Gadamer enabled the researcher to explore nurses’ experiences from their perspective while at the same time being cognisant of her own palliative care experience. In depth interviews were conducted with seven nurses from a variety of clinical areas throughout a Dublin teaching hospital. The interviews produced rich descriptions of the difficult dilemmas nurses experience in everyday practice. The data revealed fifteen characteristic but interwoven aspects of care relating to ethical decision making, these were then clustered into three major themes, which encapsulate these experiences. The themes are difficult dilemmas - treatment decisions, difficult dilemmas - participation in decisions and organisational constraints. One of the most significant findings from the study and consequent recommendations relates to the distress suffered by nurses, and the need for formal support in dealing with complex ethical decisions in day to day practice.