Nutrient runoff from agriculture practices poses a significant risk to waterway health and can have long-lasting and complex implications for the environment, ecosystems, and the human population. Consequently, a systematic quantitative literature review (SQLR) was conducted to identify different nutrient runoff mitigation strategies (NRMS) that are currently used globally to prevent or remediate environmental damage from excessive agricultural fertilisation. Empirical data on the outcomes from various NRMS from the reviewed studies were used to evaluate the strategies based on environmental benefit, implementation cost, and practicality perspectives. An overall assessment of the feasibility of NRMS was determined, and a macro-level assessment of the reported barriers preventing the widespread implementation of NRMS was provided. Identified research gaps and issues included a dearth of literature covering nutrient runoff mitigation, scepticism from agricultural landowners to voluntarily adopt policy without substantial incentives, and a general lack of cost/benefit analyses, including an understanding of the uncertainty associated with NRMS that can inform decision-makers about effective and efficient strategies for different site situations. Synthesis of SQLR data facilitated the development of a comprehensive nutrient runoff decision-making framework which addresses present limitations and provides site-specific NRMS recommendations for policymakers to implement.