Making Nursing Activities Visible in Outpatient Care: A Nationwide Descriptive Study of Nurse‐Led Clinics in Italy (ENLIGHT‐AMB)

Background: Nurse-led clinics (NLCs) are increasingly recognized as a strategic component of outpatient care delivery; however, in many health systems, including Italy, their role remains poorly documented, under-recognized in health information systems, and weakly integrated into organizational governance. This phenomenon contributes to the persistence of “Hidden Nursing Care,” limiting nursing visibility and evidence-based service planning. Purpose: To provide the first nationwide descriptive mapping of NLCs in Italy, examining their distribution, organizational characteristics, activity volumes, service typology, and professional workforce profile. Methods: A national cross-sectional study was conducted as part of the ENLIGHT-IT project. Public healthcare facilities were recruited across Italian regions. Data were collected between January and June 2024 using three structured instruments: (1) facility-level survey on NLC organization and activity; (2) nurse survey including sociodemographic and professional characteristics and the Practice Environment Scale of the Nursing Work Index (PES-NWI); and (3) an annual log of nursing activities performed. Descriptive statistics were used. Results: Twenty-seven healthcare facilities from 12 regions reported data on 279 NLCs and 940 nurses. NLCs delivered 2,047,058 nursing activities and assisted 533,212 patients in 2023. Clinics operated a mean of 4.2 days and 24.3 h per week. The largest service categories were general nursing (55.9%), wound care (11.1%), and chronic care management (10.0%). Most NLCs were administratively affiliated with medical (42.9%) or surgical departments (26.5%). The nursing workforce was predominantly female (76.4%), with a mean age of 51.4 years and extensive experience (mean 26.9 years). PES-NWI results indicated strong leadership support but insufficient staffing. Conclusions: NLCs constitute an established and high-volume component of outpatient care in Italy, yet their organizational positioning remains fragmented. Implications for Public Health Nursing: These findings highlight the need for formal recognition, standardized documentation, and dedicated policy frameworks to support equitable access to nurse-led outpatient services.