Nursing assistants in limbo: why the new role isn’t taking off

No professional role has been the subject of more controversy or sparked as much debate as that of the nursing assistant, which was incorporated into the National Collective Labour Agreement of 27 October 2025 but, to date, remains entirely absent from healthcare organisations. The process leading to its establishment has been complex, involving two State-Regions Agreements, its implementation by the Government via a Prime Ministerial Decree (DPCM) and its recognition within the collective agreement. However, no public recruitment competitions can be found on healthcare organisations’ websites, likely because, following the publication of the Prime Ministerial Decree in June 2025, it was necessary to wait at least six months before anyone could obtain the qualification certificate, whilst the training courses could last up to 12 months.

The objections mentioned stem from at least half of the trade unions and even from those directly affected – namely, social and healthcare workers and their association, Migep; but even the nurses are not entirely convinced by this form of ‘assistance’ they have been given. It seems that it is viewed favourably only by regional councillors, particularly those from a region in the north.

Adding to the overall picture of considerable uncertainty surrounding the role of nursing assistants, a ruling has now been issued by the Lazio Regional Administrative Court which appears interesting – not only in terms of the specific issue at hand, but also as food for thought on the mechanisms of collective bargaining. The Lazio Regional Administrative Court, Third Quater Section, in its judgement no. 14262 of 14 August 2026, declared inadmissible the appeal lodged by Nursing Up – with Migep, the Human Caring Sanità trade union and Enpapi intervening in support – against the Prime Minister’s Decree of 28 February 2025, which implemented the State-Regions Agreement establishing the new role. On the other hand, Fnopi, as well as 10 of the regions that signed the 2024 State-Regions Agreement, appeared as interveners in support of the case, thus making it quite clear which parties were in favour of the role of nursing assistant.

The Regional Administrative Court (TAR) delivered its ruling along two distinct lines of reasoning, one formal and the other substantive: the appeal was initially declared inadmissible and, subsequently, unfounded. Among the reasons for inadmissibility is the fact that Nursing Up is a signatory to the National Collective Labour Agreement for the Healthcare Sector dated 27 October 2025, which provides for the role of nursing assistant. The reasoning on which the administrative judges based their decision to declare the appeal inadmissible appears simple and perhaps overly straightforward, but it is grounded more in common sense than in strictly legal principles. There does not appear to be any formal legal constraint preventing a party that has signed a collective agreement from bringing legal proceedings against a single clause within that agreement. Moreover, the challenge was directed at an administrative act – otherwise the Regional Administrative Court would not have had jurisdiction – and not the National Collective Labour Agreement, which played a purely declaratory role on this matter and certainly not a constitutive one, given that the establishment of healthcare and social-healthcare roles is a matter reserved for the legislature. In this regard, the Regional Administrative Court also notes that an association or trade union may take action to protect the collective interests of the category it represents when these interests are common and homogeneous. According to the judges, in the case in question, no common interest across the entire nursing profession had emerged; in support of this reasoning, they cited the intervention of the FNOPI as a third party, which had taken a position contrary to that of the claimant in the proceedings. Some doubts remain as to whether the trade union in question had any interest in bringing the action.

Turning to the substance of the dispute, the claimant trade union, Nursing Up, had challenged the Prime Ministerial Decree of 28 February 2025, arguing that the new role had been assigned tasks of a strictly healthcare nature attributable to the nursing profession. The Court carried out a review of the nursing role, referring to Ministerial Decree 739/1994, according to which a nurse is responsible for general nursing care, acts both independently and in collaboration with other healthcare and social care professionals and, where necessary, makes use of support staff. And, according to the Regional Administrative Court, the nursing assistant falls precisely within this model. The new role does, in fact, belong to the category of healthcare support staff and must carry out its duties on the basis of precise instructions from the nurse. The nursing assistant is therefore not recognised as having the independent capacity to identify and plan care. In essence, the nursing assistant was not intended to carry out tasks falling within the exclusive remit of the nurse, but solely to act as a support role. In conclusion, the appeal was dismissed, with costs shared.