Direct Request (CEACR) - adopted 2023, published 112nd ILC session (2024)

Nursing Personnel Convention, 1977 (No. 149) - Italy (Ratification: 1985)

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Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee welcomes the detailed information provided by the Government on the application of the Convention, including legislation, collective bargaining agreements and other relevant documents attached. With respect to the application of Article 2 of the Convention, the Committee notes the Government’s indication that the National Health Plan (NHP) (Patto della Salute) 2019–21 aimed to further optimize good governance in the health sector, improve the quality of health services, and equity and universal access to health services. The NHP 2019–21 was approved on 18 December 2019, together with a budget and program, and includes the strengthening of human resources as one of its principal objectives. The Committee notes the Government’s indication that, according to data available from the National Statistics Office (ISTAT), in 2017, there were 406,000 nurses in employment, including paediatric nurses. Despite an increase in the number of nurses employed in different areas of the National Health Service (Servizio Sanitario Nazionale “SSN”), nursing personnel continue to be concentrated in hospital services, where 78 per cent of nurses were employed in 2016. Women continue to outnumber men in the profession, making up almost 75 per cent of the nursing workforce, while men make up only one out of every four nurses. According to the European Observatory on Health Systems and Policies report “Italy: Health System Summary” (December 2022), the acute lack of nurses in the country persists. The number of nurses per 100,000 inhabitants in Italy is considerably lower than the EU average, especially in lower-income regions (626 compared with 835). In addition to shortages, there are also regional imbalances in the numbers of healthcare workers across the country. The report attributes the causes of the shortage to declining investment in health personnel, a reduction in the overall number of health workers, including both physicians and nurses, and a deterioration of working conditions, especially in regions under recovery plans. In respect of gender disparities, the report notes that, with women earning 24 per cent less than men, Italy ranks among the worst EU countries for overall working conditions of female health professionals. Lastly, the report indicates that in terms of health worker mobility, Italy has experienced an increase in outflows, especially among young practitioners, with a simultaneous increase in inflows for certain categories of health professionals, such as nurses, accompanied by attempts to ease the entry process to respond to workforce shortages. As of 2012, foreign nurses made up 10 per cent of the total nursing workforce. Following the multiple challenges faced by the country during the COVID-19 pandemic, the Government submitted a National Recovery and Resilience Plan (NRRP), which was approved by the European Union on 31 July 2021. The NRRP sets out the investment and development priorities for Italy from 2021 through 2026 and identifies six primary missions, one of which (mission 6) focuses wholly on healthcare. The NRRP indicates that the COVID-19 pandemic highlighted the need to strengthen the capacity of the SSN to provide adequate services across the entire country, particularly given the aging of the population, a significant and growing percentage (40 per cent) of whom suffer from chronic diseases. The NRRP aims to make the healthcare service more accessible to citizens, considering homes as the first point of care. To this end, interventions include the creation of 1,228 community homes by 2026 as places of access and care of chronic patients, distributed throughout the country, and strengthening of home care and telemedicine, with a focus on patients over the age of 65 with chronic illnesses. The Committee notes that, in May 2020, the Government formalized the role of “family and community nurses” to strengthen home-based care and support the operation of new special units for continuity of care (Unità Specialli di Continuità Assistenziale), allocating €480 million to hire some 9,600 family and community nurses in 2021. The Committee takes note of these developments with interest as they demonstrate Italy’s recognition of the importance of significantly increasing investment in the health sector with a view to anticipate the rise of the demand for nurses in the near future. In this respect, it notes that, according to the OECD report “Health at a Glance: Europe 2022”, the demand for nurses is expected to continue to rise in coming years, due to the aging population and the retirement of large numbers of nurses in the EU region. In comparison with the EU average of 8.3 nurses per 1,000 population in 2020, the OECD notes that Italy has relatively low numbers of nurses. The Committee requests the Government to provide with its next report detailed updated information, including statistical data disaggregated by sex, age and region, on the nature, scope and impact of measures taken under the NRRP to strengthen the SSN and to indicate whether it is foreseen to carry out an assessment of the situation upon the plan’s expiry in 2026 with a view to feeding into the design of the national policy concerning nursing services and nursing personnel. In particular, the Committee would like the Government to supply information on measures taken or envisaged to invest in education and training and improve working conditions, including career prospects and remuneration, to attract and retain both women and men in the nursing profession as well as to increase the quantity, quality and equitable distribution of health professionals, including nursing personnel.

Articles 3 and 4. Nursing education and training. The Government reports that the educational and training requirements for nursing personnel have remained unchanged since the adoption of Ministerial Decree No. 270 in 2004, which introduced a 3+2 approach to training. This approach involves a 3-year degree program to ensure students gain a strong foundation in general scientific topics and specific knowledge, followed by an optional 2-year course for advanced training in specialized fields. Additional qualifications such as specialization diplomas, research doctorates, and master’s degrees are also available. The Government has introduced measures to mandate continued training for nursing personnel to update their professional skills. A new manual on continued training, effective since January 1, 2019, requires health professionals to complete 150 credits of continuing training every three years. Despite a significant shortage of nurses in the country, the Government has increased the number of openings for nursing students through Ministerial Decree No. 616 in July 2019, adding 311 places, bringing the total to 15,069. It is noted that the Ministry of Education, University, and Research had already increased the total openings by 308 the previous year, resulting in a gain of 619 places in two years, which was considered the maximum achievable given the teaching capacity in Italian universities. The Committee requests the Government to continue providing information on the nature and impact of measures taken to progressively increase the number of places available for nursing while at the same time continuing to strengthen and expand the teaching capacity of nursing schools.It requests the Government to provide detailed updated information on ongoing developments with respect to the national system of education and training for nursing personnel, including statistical data on the number of students and the number of graduates, disaggregated by sex and region.

Articles 5 and 6. Collective bargaining in the health sector. The Committee notes the text of the collective bargaining agreement for health sector workers 2016–18 transmitted by the Government. It further notes the information provided by the Government in response to the Committee’s previous comments concerning the procedures governing the resolution of employment disputes in the nursing sector. The Committee requests the Government to continue providing updated information with respect to collective bargaining in the nursing sector, including updates in relation to dispute settlement through negotiations or mechanisms that ensure the confidence of the parties. Please also continue to supply information on how it is ensures that nursing personnel enjoys conditions at least equivalent to the those of other workers, including as regards education, training, occupational safety and health, employment, remuneration and other working conditions.

Article 7. Occupational safety and health of nursing personnel. Noting the significant impacts of the COVID-19 pandemic on health workers, including nursing personnel, during the reporting period, the Committee notes with interest measures taken in the context of the pandemic to provide specific protections for these workers. In particular, the Committee notes the health and safety protocol signed on 25 March 2020 by the Italian General Confederation of Labour (CGIL), the Italian Confederation of Workers’ Trade Unions (CISL) and the Italian Labour Union (UIL) with the Ministry of Health, which sets out standards of protection for health staff, including provision of personal protective equipment and emergency measures aimed at maintaining and increasing staffing. Noting the elevation of the right to safe and healthy working conditions to the rank of a fundamental right at work, the Committee wishes to invite the Government to indicate in its next report how the new national policy concerning nursing services and personnel will be used to continuously adapt national occupational safety and health regulatory framework to the special nature of nursing work and of the environment in which it is carried out so as to better prevent, minimize and address occupational risks for this category of workers.