Focus groups were completed as preliminary work to prepare for a formative evaluation project to design a palliative care program in adult intensive care units (ICUs). Twenty-two ICU staff nurses from the medical ICU (n = 10), surgical ICU (n = 6), and neuroscience ICU (n = 6) participated in focus groups to elucidate nurses' viewpoints of caring for critically ill and dying patients in ICUs. Five major themes were identified in the analysis: (1) helping the patient through, (2) telling bad news, (3) grieving as a process, (4) family as the patient, and (5) the dying patient's effect on the nurse. Nurses also identified how palliative care was currently being used in the ICU. Findings support the need to build strong collegial relationships between members of the healthcare team in order to effectively support communication about end-of-life decision making in the ICU setting.