BACKGROUND: Witnessing patient death for the first time poses significant challenges for nursing students. Understanding their experiences can inform improvements in educational and support strategies within nursing programs. AIM: This qualitative systematic review aimed to examines nursing students' initial encounters with patient death, emphasizing their perceptions, emotional responses, and coping mechanisms. DESIGN: Qualitative systematic review. REVIEW METHODS AND DATA SOURCES: A comprehensive search was conducted across ten electronic databases from their inception until February 16, 2024, with an update on October 30, 2024. Eligible studies were evaluated for quality using the Joanna Briggs Institute Critical Appraisal Checklist. Data extraction was performed using the standardized tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. The findings were synthesized, and the ConQual tool assessed the confidence in the results. RESULTS: This systematic review included 16 studies involving 285 nursing students. Qualitative analysis identified 154 findings, categorized into six themes: (1) holistic support for patient comfort and dignity in dying, (2) perceptions of death, (3) confronting the challenges of patient death, (4) emotional impacts on students, (5) adjustments following patient death, and (6) witnessing death through novice perspectives. CONCLUSIONS: The first encounter with patient death during clinical practice significantly impacts nursing students. Comprehensive death education and robust support systems are essential for enhancing students' coping abilities. Educators and clinical practitioners should implement support strategies that address students' needs, helping them confront patient death with composure and professionalism.