Nurses: the real issue is labour market inefficiency, new models must be explored
The nursing shortage in Italy is the symptom of a structural inefficiency in the labour market, as well as a numerical emergency. This is the central argument of the Eurispes study entitled Beyond Salaried Employment. New Organisational Models of Work in the Nursing Sector, which calls for the debate to shift from “how many nurses are missing” to “how” the system employs, retains and makes the most of them. The evidence emerging from the study points to the need to regain efficiency and explore different forms of work and alternative organisational mechanisms.
The nursing labour market displays a number of dysfunctions: precarious employment, high turnover, limited mobility, unattractive contractual conditions and barriers to the recognition of qualifications coexist, in some cases, with staff shortages and difficulties in bringing in new professionals. This paradox shows that the problem lies not only in the number of professionals available, but also in the system’s capacity to allocate them efficiently. Increasing the number of training places, on its own, yields limited results: action is needed on the organisation of work.
Italy has 6.9 nurses per 1,000 inhabitants, below the European average of 8.9, with 464,193 registered on the FNOPI single register (June 2026) and wide regional disparities (from 86.2 per 10,000 residents in Lazio to 52.2 in Campania). Yet the clearest signs of inefficiency lie elsewhere: an average salary of around €32,400, compared with an OECD average of €39,800; an average age of 45, with a growing risk for generational turnover; and an exodus of some 5,770 professionals abroad in 2025, mainly to the United Kingdom (44%) and Switzerland (24%), in search of more competitive pay and careers.
On the other hand, the system has responded to nursing staff shortages with emergency measures: at the end of 2025, almost 20,000 nurses admitted through derogation procedures were working in Italy. The nursing profession’s own representative bodies are calling for these procedures to be phased out early and for dedicated registers to be established. A further sign that stopgap solutions are no substitute for a structural policy.
The study identifies non-salaried forms of professional practice – self-employment, group practice models and, above all, contracting with the National Health Service (convenzionamento) – as one of the possible levers for regaining efficiency. The reference point is the model of general practitioners and family paediatricians: professionals who are not employees but are contracted to the SSN (National Health Service), with protections defined by collective agreements. Applying a similar approach to nurses would open up a middle way between salaried employment and pure self-employment, combining autonomy, flexibility and integration into the public service, without sliding into precariousness.
This was the direction taken by the amendments to the bill on the health professions (subsequently not pursued), which provided for the direct recruitment of nurses through freelance collaboration contracts and the recognition of nursing services within the LEA (Essential Levels of Care). This approach is now also being put forward as a legislative proposal.
Continuing to view the nursing shortage as a numerical emergency means being condemned to chase the problem with derogations and stopgap solutions. The real issue is the inefficiency of the labour market: a system that trains professionals but fails to retain them, make the most of them and allocate them where they are actually needed. Going “beyond salaried employment” means exploring mechanisms – such as contracting with the SSN – that restore efficiency, provided they are regulated with fair pay, protections and transparency.
The aim is not so much to “have more nurses” as to create the conditions for them to fully perform their role and to be retained in our country. Only an integrated approach – autonomy, protections and planning – can turn the current crisis into an opportunity for structural reform of nursing work.
