The aim is to describe Japanese palliative care nurses? experience of loss and grief. Better understanding will guide the development of psychoeducational and supportive interventions. A qualitative study was undertaken with 13 Japanese nurses working in palliative care units in Japan. Face-to-face in-depth interviews lasted 55 to 90 minutes and were transcribed, and grounded theory was used to analyze data.Four major sources of loss were identified: anticipatory grief, loss of their relationships with patients, overlap with personal loss experiences, and loss of professional self-esteem. Cultural elements such as longer hospitalization and the use of primary nursing systems were contributory factors. Nurses seek to honor both life and death. Some found meaning in their caregiving as a sustaining source of resilience despite their experience of grief.Nurses? grief was both cumulative and disenfranchised, being unrecognized by society and sometimes themselves. Support systems are vital to avoid burnout.