Objective To understand the real experience of moral dilemmas in ICU nurses, so as to provide references for managers developing interventions to improve the well-being of ICU nurses and stabilize the nursing workforce. Methods Qualitative studies on moral dilemma experience in ICU nurses were retrieved from databases, including CNKI, VIP, SinoMed, Wanfang, PubMed, the Cochrane Library, Web of Science, and Embase, the search time frame was from database inception to July 24th, 2023. The quality of the included literature was assessed based on the qualitative research quality evaluation criteria recommended by the Joanna Briggs Institution (JBI). Meta-synthesis method was applied to synthesize the research findings. Results A total of 8 articles were included, with 36 themes being extracted and categorized into 10 new categories and further synthesized into three integrated results:moral dilemma experienced by ICU nurses affected by multiple factors, emotional experience when nurses encounter moral dilemma, and strategies coping with moral dilemma. Conclusion ICU nurses experience moral dilemma. Nursing managers should understand its causes, then develop and implement effective intervention to alleviate ICU nurses′ moral dilemma, promote their physical and mental health development, and stabilize the nursing workforce.