Objective To investigate the moral distress and core competence in hospice care of ICU nurses, and to explore the mediating role of death attitude in their relationship. Methods A total of 429 ICU nurses from 4 Grade A tertiary hospitals were selected, then they were investigated by utilizing a general information questionnaire, the Chinese version of the Moral Distress Scale （MDS）, the Death Attitude Profile-Revised （DAP-R） and the Core Competence Questionnaire for Hospice Nurses. Results The participants′ score of moral distress, negative death attitude, positive death attitude, and core competency in hospice care were (78.19±32.84) points、 (40.21±9.02) points、 (66.07±9.89) points、(70.21±20.88) points.ICU nurses′ moral distress was positively correlated with negative death attitude (r=0.500,P＜0.05), negatively correlated with positive death attitude (r=-0.496,P＜0.05) and core competence in hospice care (r=-0.690,P＜0.05).Death attitude was a partial mediator between moral distress and core competence in hospice care （β=-0.332,P＜0.05), the mediating effect accounted for 42.78% of the total effect. Conclusion Nursing managers should pay more attention to moral distress of ICU nurses, take various measures to popularize the concept of hospice care and death continuing education, improve the moral environment, promote nurses to establish a scientific death attitude, so as to improve their competence in hospice care.