The condition of nurses in nursing homes (RSA) and social health care: a qualitative and quantitative analysis

“There is a lack of nurses throughout Italy”, “escape of nurses from the nursing homes”, “public competitions have drained too many nurses”. We hear these claims reverberating in our heads every time a public competition is launched. They are the result of many wrong strategic choices which, little by little, are causing the definitive removal of nurses from nursing homes (RSA) and socio-sanitary residences, the same ones that were at the center of the controversy during the COVID pandemic for their poor management1, leading to some cases also their seizure and subsequent suspension2,3. These statements, which are monopolizing the local and national information channels, give public opinion an erroneous, incomplete, simplistic and one-way interpretation of a much more complex problem. The cooperatives and companies that manage these structures, sometimes backed up by some trade union organizations (OO.SS), feel abandoned by the institutions and blame, without even realizing it, “the public system”, which pays adequately, presents greater protections, enhances the professionalism of nurses better and presents better quality standards for patients. Due to the lack of a regulation on representation, the CCNLs are often signed by trade unions that do not represent workers, thus attributing the same value to the CCNLs signed by a few dozen people as the other CCNLs and thus limiting the complete development of the bargaining. To get a clearer picture of the phenomenon, which sees nurses migrating elsewhere, let’s analyze the reasons point by point. But first, to better understand this world, we report some data.
According to the report of the Istituto Superiore della Sanità (June 2020), there are 8.5 nurses working in the nursing homes per facility (31.7 OSS) 4. Out of 3400 RSAs surveyed, 80% have an agreement with the National Health System. Furthermore, according to the GNPL National Register, the database created by the National Guarantor for the geolocation of social and health care structures on the Italian territory, by 2020 there are 4,629 RSAs in Italy (compared to 2,475 in 2007) 5. 11% of the structures declared that they do not have doctors working in the structure among the professionals involved in assistance.

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