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Objective This study seeks to explore the experiences of emergency nurses in providing care to patients nearing the end of life and to identify the needs of emergency nurses in the palliative care (PC) process.Methods A qualitative meta-synthesis approach (following Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines) was implemented to systematically review relevant qualitative studies. A comprehensive search was conducted across multiple databases, encompassing PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature; (CINAHL), PsycINFO, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang database and Scopus. The search duration was from database inception to March 2025.Results In total, 22 studies complied with the inclusion criteria and were included in the meta-synthesis. Three main themes were identified: (i) needs for emergency palliative care (EPC) and current practice in emergency departments (EDs); (ii) emotional, ethical and communication experiences of nurses in providing PC in EDs; (iii) nurses’ perceived needs for training, support and system coordination. Across studies, EPC in the ED was described as occurring alongside acute life-saving care. Nurses’ experiences and attitudes towards EPC varied significantly, ranging from positive engagement to perceived incompatibility with their roles in emergency care.Conclusion This meta-synthesis highlights the complexity of providing PC in EDs and the urgency of implementing systematic interventions. To enhance the effectiveness and quality of EPC, it is necessary to provide systematic support and targeted strategies, thereby helping emergency nurses better meet the needs of patients at the end of life.PROSPERO registration number CRD420251008755.