Nurse managers' role in providing high-quality palliative care is crucial for addressing the increasing demand in municipal care. This study aims to compile existing evidence on nurse managers' awareness of and competence in palliative care in municipal care settings. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and was registered in PROSPERO (CRD42024559183). In total, 6289 articles were initially retrieved, and 489 additional articles were identified in the updated searches. A narrative synthesis was conducted. Eight studies met the inclusion criteria and three themes emerged from the narrative synthesis: (1) Conceptual grasp of palliative care, (2) Recognition of gaps and needs, and (3) Competence in fulfilling complex responsibilities. Nurse managers' understanding of palliative care along with identified gaps and priorities shaped their competence in managing complex responsibilities related to palliative care, where confidence influenced how they performed the responsibilities. The results pointed to a knowledge gap in the explored area. Future research is needed to explore nurse managers' perspectives on how they understand and perform their leadership role in relation to palliative care.