Characterizing the Decision-Making Competency of Nurse Managers: A Scoping Review

Abstract

Objective: The purpose of this scoping review is to describe the characteristics of the decision-making competency of nurse managers. In addition, this review analyzes how technological, organizational, and contextual factors influence the development and practical application of this competency and identifies the key barriers and facilitators that specifically impact its growth and use in managerial practice. Background: Nurse managers’ decision-making abilities are essential for organizational performance in rapidly evolving healthcare systems. Despite its relevance, the specific characteristics that define this competency have not been thoroughly examined. Following our research methodology, we searched the Web of Science, Scopus, CINAHL, and PubMed electronic databases, focusing on the decision-making characteristics of nurse managers between January 2009 and February 2025. Results: Twenty-five studies were included, identifying 15 core characteristics that define nurse managers’ decision-making competency. The most frequently reported characteristics were professional values and ethics, information processing, systems and data management, and risk management. Technology was consistently identified as a critical facilitator of decision-making, enabling efficient information access and analysis. Conversely, high levels of stress and the complexity of healthcare environments were identified as the primary barriers to effective decision-making. Conclusions: Strengthening decision-making competency in nurse managers requires the development of ethical reasoning, data literacy, systems thinking, and risk evaluation. Technological proficiency is essential to enhance decision quality, while organizational stressors must be managed to reduce cognitive load and improve performance. Implications for Nursing Management: These findings support the design of targeted training programs, particularly those using simulation and virtual reality, focused on strengthening decision-making competency, a critical skill for effective nursing management. Developing this competency enhances nurse managers’ ability to navigate complex clinical and organizational challenges, make ethically sound decisions, and lead their teams with greater confidence and strategic insight.