Community care homes: as well as the medical puzzle, the nursing issue remains to be resolved

With the deadline for the launch of the Community Centres funded by the NRRP fast approaching, all the critical issues relating to the human resources essential for the effective operation of the new facilities are coming to the fore, in order to prevent the Community Centres from turning out to be empty shells. The first major problem concerns the doctors required, but the solution is closely linked to the developments surrounding the reform of general practice proposed by the Minister of Health. Moreover, another issue is equally strategic: the recruitment or sourcing of family or community nurses, the so-called ‘IfoC’.

Here, we shall attempt to take stock of the current situation and, in particular, the legal and contractual characteristics of IFoCs. Indeed, a fundamental question must be asked: who is the family or community nurse? There are numerous misunderstandings and unresolved issues; suffice it to say that even at a semantic level there is no consistency or clarity, given that official documents refer to IFoCs, but many organisations call them IFeCs, with a peculiar, indistinct use of the two terms.

One of the first instances of this role in practice can be traced back to the Region of Tuscany, which, through Regional Council Resolution No. 597 of 4 June 2018, set out the framework, the definition, characteristics of the model, responsibilities, functions and competences, as well as the relevant training pathway for the new role of family and community nurse (FCN). Subsequently, in the early stages of the pandemic, Decree-Law 34/2020 (the ‘Relaunch’ Decree) provided, in Article 1, paragraph 5, for a sort of advance on the formal establishment of the role of family (and community) nurse, for which – regardless of regional organisational models already in place, as in Tuscany – Draft Law A.S. 1346, with Marinello as the first signatory, was then pending; this aimed to establish the role but place it unequivocally among the National Health Service contractors alongside general practitioners and paediatricians of free choice. The provisional decision for 2020 was to use forms of ‘self-employment, including coordinated and continuous collaboration’ with a population-based reference framework. From 2021, however, it appears that the legislator has opted for a permanent employment contract with the health authority. The use of forms of self-employment is now effectively prohibited in the public sector, and the provisions of the ‘Relaunch’ Decree, in fact, allowed for them only exceptionally for 2020.

At present, the reference to Decree-Law 34/2020 as a legislative source is, to say the least, out of context, because it introduced the role in question without specifying anything about the legal nature of the ‘role’, not even whether it involved employment or self-employment, not to mention that it was contextualised within the state of emergency. Subsequently, Ministerial Decree 77/2022, in paragraph 6 of Annex 1, slavishly repeats the characteristics, competences and standards of the IFoC, but insists on not defining its legal nature, continuing to refer to it as a ‘reference professional role’. The problem lies precisely in the term ‘role’, which means nothing because, according to the National Collective Labour Agreement, the profession or professional profile remains simply that of a nurse.

The Agenas guidelines themselves did not specify ‘who’ the IFoC is, but only ‘what’ it does and ‘where’ it does it. The professional framework for healthcare currently comprises 31 healthcare professions, 3 healthcare practitioners and 4 residual roles attributable to the auxiliary arts of the healthcare professions. New professions or profiles are established through the procedure set out in Article 5 of Law 43/2006. The term “family nurse” does not constitute an independent profession or profile, but rather a specialisation of the nurse or paediatric nurse acquired through a first-level master’s degree pursuant to Article 6, paragraph 3, of the aforementioned Law 43/2006. A few days ago (27 May), the MUR decree establishing the clinical master’s degree in ‘Nursing Sciences in Primary Care and Family and Community Nursing’ came into force.