Nurses and other senior ward staff: a law is needed to ‘sort things out’

The eligibility of senior professionals to take part in a selection process for complex units alongside senior medical staff is by no means a straightforward issue. The ruling by the Lombardy Regional Administrative Court on this matter has attracted considerable interest, and a number of websites and individual healthcare professionals have reported on the news, highlighting the novelty and significance of the ruling for the categories concerned. The content and reasoning behind the ruling are fairly clear, but the case at the heart of the dispute is far more complex and warrants some further commentary.

Firstly, the post in question is a temporary replacement post – not a ‘substitute’ post, as stated in both the vacancy notice and the judgement – lasting not even ten months to cover the absence of the post-holder, who has been on leave of absence since 2021, presumably falling under one of the five categories of post set out in Article 22(5) of the National Collective Labour Agreement of 19 December 2019, which was in force at the time. The contractual clause in question provided for the post to be filled using the same procedure as that prescribed for an ordinary five-year post; this is why the ATS issued a public notice containing the contested rules.

It is stated that “this would be the result of a deliberate legislative choice” (paragraph 8, on page 8, of the judgement): but it is not a ‘choice’ but rather an objective fact simply due to the fact that the professional governing bodies were established three years after Presidential Decree 484/1997 came into force. It is precisely in this passage of the grounds for the judgement that the key to understanding the particular complexity of the case lies. Indeed, the ‘absence of any action by the national legislature’ is highlighted, a situation which persists to this day and serves only to create confusion and litigation. In essence, the Minister of Health should have taken note of the establishment of managerial qualifications for nurses and healthcare technicians and ensured that the legislation governing the appointment to the post of head of a complex healthcare unit was amended accordingly.

Nevertheless, the same competitive selection rules for access to the ‘new’ managerial grades were adopted eight years after Law 251/2000, by the Prime Ministerial Decree of 28 January 2008; but the next step – namely, the appointment to head complex organisations – was never taken, even though there had been at least two opportunities to amend Article 15(7) of Legislative Decree 502/1992: Law 189/2012 (the so-called ‘Balduzzi’ Law) and Law 118/2022 (European Law 2021). However, nothing has been done, and the selection processes in question for professional managers have long been in disarray, whether they relate to typically nursing or technical-healthcare facilities, or to multi-professional access schemes, as in the case covered by the judgment in question. This adjustment is essential for at least three specific reasons: the lack of training programmes for new managers, the standardisation of the required length of service, and the composition of the selection committee, comprising three clinical service directors drawn by lot from a national list maintained by the Ministry of Health.

However, this is not the only instance of government inaction, as specific regulatory amendments have been awaited for years: amendments to Presidential Decree 220/2001 regarding new job profiles, the adaptation of selection procedures for SC to allow access for managers in the professions, and the competition rules for social work managers). The adoption of the regulation updating the competition rules referred to in Article 12-quater, paragraph 2, of Law 69/2025 could provide an opportunity to address this. However, there has been no news of this amendment, nor indeed of the others that the Ministry of Health has been required to implement for years.