Background <p>In Chinese culture, discussions about death are often considered taboo, which may intensify death anxiety among nursing interns when facing end-of-life situations. Death anxiety may influence their ability to provide spiritual care, yet the underlying mechanisms remain unclear.</p> Aim <p>This study aimed to examine the relationship between meaning in life, death anxiety, and spiritual care competence among nursing interns, and to explore the mediating role of death anxiety.</p> Methods <p>This was a cross-sectional study. A cross-sectional survey was conducted among 737 final-year vocational nursing interns from a medical college in China using whole-cohort sampling. Data were analyzed using SPSS 25.0, including t-tests, ANOVA, Pearson correlations, and mediation analysis via Hayes’ process plug-in.</p> Results <p>Significant associations were observed among meaning in life, death anxiety, and spiritual care competence. Meaning in life, was positively correlated with spiritual care competence (<i>r</i> = 0.520, <i>p</i> &lt; 0.001) and weakly negatively correlated with death anxiety (<i>r</i> = -0.077, <i>p</i> = 0.036). Death anxiety was negatively correlated with spiritual care competence (<i>r</i> = -0.196, <i>p</i> &lt; 0.001). Mediation analysis showed that death anxiety partially mediated the relationship between meaning in life, and spiritual care competence, with an indirect effect of 0.019 (95% CI: 0.001–0.041), accounting for 2.24% of the total effect.</p> Conclusion <p>Death anxiety partially mediated the association between meaning in life and spiritual care competence, with a small but statistically significant indirect effect. These findings suggest that addressing death-related concerns and fostering meaning construction within nursing education may support the development of spiritual care competence, consistent with theoretical perspectives emphasizing the buffering role of existential resources.</p>