Artificial intelligence (AI)-powered chatbots, also known as conversational agents, are increasingly being investigated as solutions to address both cost and mental health provider shortages. Chatbots, which utilize large language models, are scalable and accessible, with largely positive patient satisfaction scores. This systematic review evaluates the efficacy of AI chatbots compared to other support methods in improving mental health outcomes. Seventeen high-quality randomized controlled trails (RTC) were identified by searching PubMed and Google Scholar. After examining relevance and overall quality, eight studies were chosen. Studies like He et al. (2023) and Liu et al. (2022) indicate that Chatbots consistently reduce anxiety and depression compared to passive bibliotherapy. Although chatbots were less effective than traditional therapy (Spytska, 2025), they still reduced symptoms, making them suitable for adjunct therapy, or in areas where provider shortages make traditional therapy unavailable. Danieli et al. (2022) supports combination therapy which yields the highest satisfaction. User feedback (65–80% satisfaction) demonstrates that patients were, in large part, satisfied with their experience. Although this varied, with younger patients responding more favorably, Some patients complained of repetitive responses, suggesting that refinement of the algorithm is needed. Inaccuracies (Yahagi et al., 2024), as well as ethical concerns like privacy and over-reliance, demonstrate the necessity of professional oversight. Clinical Nurse Leaders (CNL) can have a pivotal role in guiding appropriate evidence-based use, such as complementing human care, enhancing access, as well as reducing nurses’ workload by leading studies that explore automating triage, follow-up care, chronic disease management, or patient education or discharge instructions. Clinical Nurse Leaders (CNLs) are also pivotal in guiding chatbot development, assisting in the development of algorithms that support ease of use, cultural competence and are tailored to medical use. CNL are also essential in ensuring ethical use, pushing for cultural competence, oversight, and judicious use for nursing support and not replacement. Ideally, chatbots will complement human care. CNLs can spearhead their use in enhancing access, reducing workloads, and supporting underserved populations, ensuring ethical, effective mental health care delivery.