BackgroundNeonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles. ObjectiveThe objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs. MethodsSuggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions. ResultsA total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between healthcare teams, (3) ending futile care earlier, (4) realistic and honest physician communications to families, (5) providing a “good death,” (6) improved nurse staffing, (7) need for EOL education, (8) earlier entry into hospice/palliative care, (9) availability of ancillary staff, and (10) allowing parents more time to prepare for death. ConclusionsDespite the variety of obstacles encountered in providing EOL care to dying infants and their families, NICU nurses can influence environmental factors, help improve communication, and use self-assessment tools to identify current EOL care practices.