Background: In high-stakes healthcare settings, nurse leaders often encounter complex and time-sensitive decisions that traditional rational-analytical models struggle to address. Aim: To synthesize evidence on intuitive decision-making in nursing management, focusing on its definitions, theoretical foundations, facilitators, barriers, and effects on patient care and leadership. Methods: A systematic search was conducted in PubMed, SCOPUS, Web of Science, PsycINFO, IEEE Xplore, and Google Scholar. The search was limited to English-language, peer-reviewed studies published between 2020 and 2025. Following the PRISMA guidelines, 723 records were screened, and 11 studies met the eligibility criteria. Results: The 11 included studies originated from six countries and encompassed various methods. Intuition was consistently defined as rapid, experience-based pattern recognition. RPD and NDM were the dominant theoretical models. Facilitators included experience, emotional awareness, simulation, and supportive team dynamics. Barriers included a punitive culture, fear of error, and lack of formal training. Intuition enhanced speed, accuracy, and early intervention in patient care. ML tools were shown to augment, not replace, intuitive nursing judgment in insulin dosing decisions. Conclusion: Intuitive decision-making is crucial for effective nursing leadership and should be integrated into educational programs, supported by simulation training, and validated through reflective practices.