Making Nursing Activities Visible in Outpatient Care: A Nationwide Descriptive Study of Nurse-Led Clinics in Italy...

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.

To provide the first nationwide descriptive mapping of NLCs in Italy, examining their distribution, organizational characteristics, activity volumes, service typology, and professional workforce profile.

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.

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.

NLCs constitute an established and high-volume component of outpatient care in Italy, yet their organizational positioning remains fragmented.

These findings highlight the need for formal recognition, standardized documentation, and dedicated policy frameworks to support equitable access to nurse-led outpatient services.