Without foreign nurses, the Italian healthcare system collapses.

I am Competent, or rather not. They are a resource, or rather not. Professional organizations and unions often describe foreign nurses as a problem due to a damnably complex combination that can be summed up in two words: an emergency approach. Yet without them, entire departments would grind to a halt due to staffing shortages.

The topic is controversial and crucial because it concerns the care of human beings and the most vulnerable groups. Everyone agrees on one thing, however: these professionals are indispensable. With 6.6 nurses per thousand inhabitants, Italy is below the EU average of 8.4, while the unmet need is estimated at between 63,000 and 220,000 nurses needed to reach the levels of France, Germany, and Spain. While we hope to stem the hemorrhage of nurses abandoning the National Health System, 40% of active staff will reach retirement age within the next 15 years. According to AMSI, the association of foreign doctors in Italy, the number of doctors and healthcare workers in Italy has reached over 100,000.

President Foad Aodi never tires of repeating that without them, the healthcare system would collapse. "Several thousand have arrived thanks to the Cura Italia decree: a significant figure that cannot be ignored. Let's say no to statements that could fuel divisions and prejudices, which unfortunately contributed to the increase in discrimination in 2024 ," he explains to VITA. " Over the last five years, there has been an increase of 30,633 healthcare professionals of foreign origin , and only 10% are members of trade unions. A white army that Italian society, at the mercy of demographic decline and the aging population, needs. Also because university enrollments continue to decline, and graduates, if they can, go to other European countries where they are better paid and more valued." The Court of Auditors ' 2024 General State Budget Report, released on June 26, 2025, also addresses this issue, highlighting the critical shortage of doctors: "In addition to staff shortages in public facilities, there are also worrying signs: the lack of turnover in some specialties, growing critical issues with nursing staff, partly due to the high number of expected retirements; and the difficulties in making the structures envisaged for the reform of local healthcare operational, where promoting integration and enhancing the role of general practitioners (GPs), pediatricians (PLSs), and outpatient specialists in the new regional organizational models remains central to their functionality."

The ISMU Foundation has published a lengthy report titled: "Let's not put a Band-Aid on it. The recruitment of nurses abroad within the framework of a new governance of the nursing profession ." "There is certainly a training problem for those coming from less developed healthcare systems who require supplementary training, as well as the issue of a basic knowledge of the Italian language, but if we look at the forecasts of demand, these figures are absolutely indispensable," says Laura Zanfrini, professor of Sociology of Migration at the Catholic University of the Sacred Heart and editor of the report. "However, the Italian healthcare system cannot rely exclusively on foreign professionals to plug the gaps: there is no structural institutional management capable of valorizing the nursing staff who carry out the extremely delicate and ethical task of providing care. They are recruited through transitional measures and often also face discrimination, creeping racism, and excessive workloads." Several hospitals have in fact created projects to care for those who care for others . For example, at the Gemelli Hospital , Ohana' , which means family in Hawaiian, was created: a program to promote the inclusion of foreign staff and patients from other cultures.

Rosa Melgarejo , a nurse of Peruvian origins, founded the Nurses of the World association after witnessing an episode of discrimination. " The Italian daughter of a Bolivian colleague of mine was asked by a patient on her first day of work, 'Do you understand my language?' and she didn't want to work anymore . Her mother tried to explain to her that similar things had happened to her all her life. From there, I realized I had to form a group where we could meet and share work experiences, regardless of nationality or culture. Because now there's a constant flow of nurses arriving from other countries who have no point of reference, are alone, and sometimes need additional training and psychological support, not just linguistic support." At the Ospedale Maggiore Policlinico, she trains newly hired nurses. "I see many young people, especially women, of second generation who enter public hospitals, but economic inequality and discrimination drive them to emigrate like the natives do. Furthermore, many arrive with different expectations and then often find themselves working in geriatric wards, in nursing homes. And, given the widespread lack of motivation, they too leave if they can." According to the ISMU report, Italy is and will be dealing with what the International Labour Organization, even before the pandemic, had called the global care crisis because in less than twenty years, more than one in three Italians will be over 65.

In 2024, the government announced the launch of a program to recruit 10,000 Indian nurses with recognized qualifications, which has sparked widespread criticism and outcry, including from corporate circles. The president of the national nurses' union Nursing Up, Antonio De Palma, stated: "Rather than investing in our professionals, they are trying to patch up the situation with a bilateral agreement to facilitate the entry of thousands of nurses from India, while there are thousands of Italian nurses scattered around the world, eager to return, if treated with dignity. This ignores the true needs of the system and the real causes of the crisis in the nursing profession in Italy. It's as if, to cure a disease, instead of using a drug capable of eradicating it at the root, we decided to treat only the symptom. We are living in an era in which the nursing profession is increasingly at risk. Over the past 15 years, registrations for nursing exams have halved, and thousands of nurses have reluctantly chosen to accept contracts abroad, leaving our country for significantly more decent salaries that they certainly can't earn here. This should sound yet another alarm bell. It's not a lack of talent or vocations, but the precarious conditions we're forced to work in, the lack of professional appreciation, and inadequate salaries. This is why young people choose other careers.

The contribution of foreign professionals has ensured the stability of entire departments during the pandemic and continues to do so daily. However, professional organizations maintain that recruiting abroad cannot be the definitive solution. The National Federation of Nursing Professions (FNOPI) has always been cautious about the growing influx of foreign nurses, despite new approaches with the ministry and agreements with universities abroad in individual regions. Because they work under the exemptions established during the pandemic, many arrive without obtaining recognition of their qualifications or formal registration in the Italian Register. These critical issues are also analyzed in the ISMU report, including the chaotic and not always transparent operations of recruitment agencies.

Laura Zanfrini analyzed the obstacle course for nurses with migrant backgrounds, which does not end with the ability to legally practice in Italy. The ISMU report states: "The work settings of healthcare professionals, in addition to being characterized by critical issues, are not always inclusive of those from diverse linguistic and cultural backgrounds. Furthermore, the foreign-born nurses interviewed, despite their extensive experience in Italy, repeatedly denounced the lack of equal opportunities in the management of shifts and tasks, in the access to training opportunities, in the distribution of responsibilities, and especially in professional development and advancement paths. This complex set of critical issues leads to disillusionment and demotivation, thus risking compromising both the ability to retain them and, in the medium term, the ability to attract new staff, diverting them to destinations deemed more advantageous." AMSI President Foad Aodi notes that approximately 11,000 nurses and physiotherapists of foreign origin are still unable to practice. They are held back by bureaucratic delays and the lack of recognition of their qualifications, and he emphasizes the need for change. " We need to overcome precarious employment and barriers to recognition. It is essential to intensify collaboration with FNOPI. The goal is to guarantee rights, training, and stability for all nurses, both Italian and foreign. The entry of other professionals from abroad must be planned only based on actual need."

Rosa Melgarejo concludes: "There's a lack of integration pathways, institutional direction that addresses the emergency approach, and the lack of professional training in some countries, and temporary employment agencies represent a kind of jungle. Furthermore, we mustn't forget that foreign nurses end up primarily in private facilities and nursing homes, where, in addition to having many healthcare workers of foreign origin, there are also many patients with a migrant background because foreign workers are also aging (and retiring). Therefore, it's fair to believe that we are increasingly indispensable, figures that should be better valued, and should be recruited with adequate professional training and language skills, but this shouldn't create a war between the poor."

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