Abstract Background Alarm fatigue is a critical issue in intensive care units, negatively impacting nurse well-being and patient safety. Understanding nurses’ experiences and management strategies is essential for developing effective interventions. Objective This study aims to elucidate the current practices of nurses in responding to alarms and their experiences with alarm fatigue. Methods We conducted a systematic review and meta-synthesis of qualitative studies. PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Wiley databases were searched from inception to May 2024. The search syntax included the following keywords and Boolean operators: (“alarm fatigue” OR “alarm management” OR “clinical alarm”) AND (“ICU nurses” OR “critical care nurses” OR “intensive care nurses”) AND (“experiences” OR “perceptions” OR “strategies” OR “interventions”). Eligible studies included qualitative research exploring ICU nurses’ experiences and responses to alarm fatigue. The risk of bias was assessed independently by two researchers using the CASP (Critical Appraisal Skills Programme) Qualitative Research Checklist. Studies were categorized as high, medium, or low reliability based on their adherence to the CASP criteria. Data were analyzed using thematic synthesis. Results Of 460 identified records, 11 studies met the inclusion criteria, all of which demonstrated high methodological quality. The synthesis yielded nine key findings organized into three main themes: (1) Adverse outcomes of frequent alarms. (2) Causes of alarm fatigue. (3) Effective strategies to manage alarm fatigue. Frequent ICU alarms increase nurse workload, erode alarm system trust, heighten alarm fatigue, and endanger patient safety. Conclusion To address ICU alarm fatigue, interventions should focus on reducing false alarms, enhancing alarm reliability, strengthening nurse training, optimizing work environments, and providing psychological support. These measures are crucial for improving patient safety and nurse well-being. Future research should explore the long-term impact of these interventions. Registration PROSPERO CRD42024539569.