Background: Patients in clinical settings are not lonely islands; they have relatives who play a more or less active role in their lives. Objectives: The purpose of this article is to elucidate the ethical challenges nursing staff encounter with patients’ next of kin and to discuss how these challenges affect clinical practice. Research design: The study is based on data collected from ethical group discussions among nursing staff in a nursing home. The discussions took place in 2011 and 2012. The (...) data were analysed and interpreted by using hermeneutic methodology. Ethical considerations: All the data have been anonymised and handled with confidentiality. Written informed consent was obtained from all participants. Findings: Ethical challenges relating to patients’ next of kin were found to be an issue frequently discussed in the groups. Our findings indicate that next of kin have different characteristics, categorised as ‘the professionals’ and ‘the shadows’. In this article, we will describe the next of kin’s characteristics and the ethical challenges and practical implications that nursing staff experience in this connection. Discussion: We will discuss the findings in the light of the four basic principles of medical ethics and propose interventions to help nurses manage ethical challenges related to next of kin. Conclusion: The study reveals the need to enhance nursing staffs’ communicative and ethical skills on an individual level, but most importantly, to establish routines in clinical settings for informing and following up next of kin in a systematic and structured way. (shrink)