Objective To investigate the levels of palliative care knowledge, attitudes, and death anxiety among nurses working in urban and rural nursing homes in Jiangsu Province, to identify any differences and provide references for improving quality of palliative care services. MethodsWe conveniently selected one urban and one rural nursing home from each of the 13 prefecture level cities in Jiangsu Province, and a total of 546 nurses answered a battery of questionnaires, including a demographic data questionnaire, the Palliative Care Quiz for Nursing (PCQN), the Frommelt Attitude Toward Care of the Dying scale form B (FATCOD B), and the Templer′s Death Anxiety Scale (T DAS). ResultsThe total PCQN score was 9.07±2.43, with no statistically significant difference between urban and rural nursing home nurses (P>0.05). However, nurses in rural nursing homes scored significantly higher on the negative domain of the FATCOD B compared with the urban ones (P<0.05). Similarly, nurses in rural nursing homes scored higher on dimension scores of affective, stress and pain, and overall score of the T DAS, than their urban counterparts (all P<0.05). Multiple linear regression analysis revealed that, experience of care of the dying patients, and receiving palliative care training were predictors of palliative care knowledge (both P<0.05). Factors influencing attitudes toward care of the dying included years of work experience, discussing death with patients or families, receiving palliative care training, and the region of the nursing home (all P<0.05). Age, education level, years of work experience, and the region of the nursing home were factors influencing death anxiety of nurses (all P<0.05). Conclusion Palliative care knowledge of nursing home nurses in Jiangsu Province needs to be improved, and nurses′ attitude toward care of the dying and death anxiety have urban rural differences. Palliative care education and training should be strengthened, particularly for nurses working in rural nursing homes.