Objective To explore the effect of ICU nurses′ role clarity and moral dilemmas on spiritual care ability, and to provide reference for the development of intervention measures aiming at improving ICU nurses′ spiritual care ability. Methods A total of 306 nurses in ICU from 6 3A general hospitals in Zhejiang province were selected to fill out the demographic questionnaire, the Spiritual Care Ability Scale, the Role Clarity Scale and the Moral Dilemma Scale. Results The nurses scored (77.70±16.43) points in spiritual care ability, 59.81(IQR:15.0-88.0) points in moral dilemma, and (32.22±5.37) points in role clarity. Nurses′ spiritual care ability were positively correlated with role clarity (r=0.442, P<0.05), while negatively correlated with moral dilemma (r=-0.424,P<0.05). Multiple linear regression analysis showed that education level, whether having received training on spiritual care , role clarity and moral dilemma were the influencing factors of spiritual care ability (all P<0.05). Conclusion ICU nurses′ spiritual care ability is at medium level and needs to be further improved. Nursing managers should offer training programs, and take targeted measures to improve ICU nurses′ spiritual care ability.