Introduction: clinical decision-making is vital in nursing and impacts care quality and patient safety. The increasing complexity of healthcare demands nurses to integrate theoretical knowledge, clinical experience, and professional judgment. This review synthesizes literature on clinical decision-making in nursing, focusing on theoretical models and strategies for enhancing nurses’ competencies globally. Method: a systematic literature review was conducted using Scopus, PubMed, ScienceDirect, and CINAHL. English-language articles published from 2015 to 2024 were included. Data were thematically analyzed to identify consistent models, themes, and influencing factors. Results: analysis of 18 articles revealed six core themes in clinical decision-making: recognizing cues, analyzing cues, prioritizing hypotheses, formulating solutions, taking action, and evaluating outcomes. Clinical experience, critical thinking, intuition, team collaboration, technology, cultural context, and professional ethics were key influencing factors. Effective decision-making often combines analytical and intuitive approaches, particularly in complex or emergencies. Conclusions: clinical decision-making is a multifaceted process shaped by individual factors, workplace dynamics, and systemic support. These findings highlight the need for tailored, evidence-based education and training programs to strengthen decision-making skills among nurses across diverse healthcare settings. © 2025; Los autores.