Saudi Arabia's Vision 2030 has initiated comprehensive healthcare transformation emphasizing primary healthcare restructuring and expanded professional roles for nurses. This study examines the evolution of nursing administrative functions within the newly implemented Model of Care framework across Saudi health clusters. Through systematic review methodology, this research explores how cluster-based integrated care delivery models have redefined nursing administrative competencies, leadership responsibilities, and operational management functions. The cluster-based system organizes healthcare providers under unified administrative structures serving approximately one million people each, fundamentally shifting nursing roles from traditional clinical supervision to encompass strategic planning, resource management, quality oversight, and health system governance. Findings reveal significant role expansion in workforce management, quality assurance, resource allocation, policy implementation, and interdisciplinary coordination. However, challenges persist including low nursing school capacity, high expatriate employment, labor market fragmentation, rural workforce shortages, and gender-related barriers. The transformation requires enhanced educational frameworks, professional development pathways, and organizational support systems. This study contributes to understanding nursing workforce adaptation within healthcare system reforms and offers evidence-based recommendations for sustainable nursing leadership development aligned with national transformation objectives. Results indicate that successful implementation depends on strengthening regulatory frameworks, developing competency-based training programs, and fostering supportive organizational cultures that value nursing leadership contributions.