Within the next five years, the Italian healthcare system is heading for a real collapse. More and more nurses are resigning, seeking opportunities abroad or in other sectors, where they do not have to face night shifts, holidays, or risk illnesses, lawsuits, and enormous responsibilities which, in conditions of excessive fatigue, can have tragic consequences. The decline in working conditions for nurses in Italy has deep roots. Starting from the hiring freeze and the regionalization of healthcare, the system has been severely weakened, turning what was once one of the most envied healthcare services in the world into a sieve leaking water from every side. The hiring freeze has frozen workforce renewal, leaving staff with an average age of 48.2 years, one in four of whom is over 55. In other professions, workers of this age are relieved from physically demanding tasks, but this is not the case in healthcare. Here, the few nurses left must cope with unsustainable workloads and, instead of receiving praise, are often mocked by management and victims of violence from patients. With regionalization, the number of managers has increased disproportionately, accompanied by high salaries and generous productivity bonuses. Meanwhile, the number of nurses and midwives is constantly and inexorably decreasing. This has created an unsustainable situation, where bureaucracy seems more important than patient care and well-being. In the last twenty years, about 180,000 healthcare professionals have left Italy, taking with them invaluable skills. Training a doctor costs the state about 150,000 euros, while training a nurse costs about 22,500. In total, Italy has invested over 3.5 billion euros in a workforce that is now enriching the healthcare systems of other countries. From 2011 to 2021, 125 hospitals were closed in Italy. Yet, it is expected that in the coming years the need for nurses will double. The government's solutions have proved ineffective: recruiting staff from abroad or creating hybrid roles will not solve the problem. The nursing profession must be made more attractive through salary increases, benefits, tax breaks, and new hires. In the rest of Europe, nurses' salaries range between 2,500 and 9,000 euros per month, while in Italy they are well below average. Italian nurses have to face an ever-increasing cost of living, including rent, bills, and healthcare expenses. Many are forced to give up life projects such as starting a family or moving, and often end up in debt just to make it to the end of the month. A recent survey conducted by Nursing Up Emilia Romagna on over 3,000 nurses revealed that 98.2% are dissatisfied with their salary, and only 8% work in a healthy environment. Work overload, grueling shifts, and burnout are now the norm. Worsening the situation is the lack of psychological support, pushing many nurses to consider leaving the profession. According to the “European Work-Life Balance 2023” report by Remote, Italy is in last place in Europe for work-life balance. Even compared to countries with weaker economies, such as Greece and Portugal, Italy stands out for excessive working hours, inadequate holidays, low salaries, and weak welfare. This deterioration is putting workers' mental health at risk, with 46% of Italians declaring themselves stressed. A study by the School of Nursing at the University of Michigan highlighted that the risk of suicide among nurses is double that of the general population, with a rate 70% higher than that of doctors. The risk of depression and burnout is also significantly higher, confirming the urgency of systemic interventions. Management must understand that improving nurses' conditions is a matter of survival for the entire healthcare system. Reducing the nurse-patient ratio to 1:6, improving the work environment, and realigning salaries to the European average are essential measures to reduce burnout and improve clinical outcomes. Recognizing the nursing profession as strenuous is also fundamental to protecting those who care for the health of the population. Nursing Up, together with the major doctors' unions, has called for essential reforms: salaries aligned with the OECD average, exclusivity allowances, recognition of the profession as strenuous, freedom of mobility, and a single national contract. If these demands continue to be ignored, an unprecedented mobilization is expected, with a major demonstration scheduled for November 20, 2024, in Rome. The time to act is now, to guarantee a dignified future for the nursing profession, but also for other professions, the commitment of politics, management, and every colleague is necessary. Let's start by strengthening a single category union, Nursing Up, the last bastion to save the National Health Service. Keep this well in mind, dear colleague. Nursing Up Union Representative Turin Dr. Giovanni Mariano
