Already a non-EU nurse and/or nurse practitioner looking into becoming one in Italy?
I have decided to write this post because as an RN and NP that has studied/worked in the United States and moved to Italy, it has been nearly impossible for me find clear information online about this possibility. It is important to firstly note that no matter what you read, Italy doesn’t currently have the equivalent of an advanced practice nurse or nurse practitioner, so it is not possible to work as such.
Below I’ll share the technicalities of becoming a nurse if you already have a non-EU degree, my experiences, and what I have found out in the process.
The general rules
The Ministry of Health is in charge of certifying the license to practice for all health professions (the “Professioni Sanitaire”), including nursing. This entity is the one that ultimately determines the recognition of foreign healthcare degrees. The official list of documents to be submitted to get your nursing education recognized is itemized in this document, and can be consulted through their website at: Ministero della salute. Now, if you take the time to look at the itemized document, you will immediately notice that the list is long and incredibly daunting. If you are serious about getting it done, my suggestion is to just start one piece at a time, and you will see that it is possible to di it. If you do succeed in gathering all the required documents and sending them to the Ministry of health, you then have to wait a few months to receive feedback. Their response will either be of rejection or conditional acceptance. The conditions aren’t precisely defined, but from what I gather recognition of non-EU degrees is dependent on the completion of about 400-500 hours of practical internship in a hospital and an Italian language proficiency exam.
To add some context, I have both Italian and American citizenship and speak both languages fluently, so you would think this process would have at least partially helped me…. but it really hasn’t.
First of all, just the act of gathering the documents necessary for the application is extremely difficult, especially if you are not a new graduate and not able to go to your university to gather them all in person. In my case, I was already in Italy, so I used a specialized UPS service to collect my documents from the university, get them certified (with the apostille) and send them to me. The UPS service took about a week and was relatively costly. This step will vary depending on your needs and situation.
Once you have gathered your documents, it is time to send them to the Ministry of health and cross your fingers. I am not sure about how it is in other Italian regions, but in Milan there is the possibility to apply through a government intermediary, called Polis Lombardia that can assist you through the whole process. I met with a very kind representative who made sure I had all the right documentation, sent it all to the Ministry via certified mail, and supported me with all communication. I highly suggest using them or a similar agency if you have the possibility.
Here comes the not so great news: if you have any idea of how complicated the bureaucratic situation in Italy is, you will understand that getting any feedback, let alone a clear decision, is nearly impossible. Unfortunately, it is important to know that the application process to get your degree recognized is not only very, frustratingly long, but also difficult to achieve. In my case, the application process took nearly 3 years, and ultimately ended in the rejection of my application.
About 6 months after I sent all the correct documentation, the Ministry of health sent a certified letter that they did not receive some key documents that I did in fact send. This happened another 2 times over the course of a couple years. Each time I (through the assistance of the intermediary I mentioned above) sent proof that everything was sent. You also have to keep in mind that since you are dealing with an Italian public entity, no business will get done in August and the surrounding months.
After about 2.5 years of this back-and-forth, I received a final letter stating that I didn’t complete the 4600 hours of mandatory didactic and practical university credit hours sufficient for having a nursing degree recognized. This was the first I had heard about such a requirement, but I have looked into it and it appears to be true. I was told that often this is overlooked, but in my case it was not.
I was upset that this key piece of information was never mentioned or written anywhere in the documentation, and it seems strange that adding all the credit hours of both my undergraduate and graduate education do not sum up to the minimum credit hour requirements for an Italian undergraduate (bachelor of) nursing degree. But at this point there was nothing else I could do; I had to accept the final rejection of degree recognition from the Ministry of Health and come up with alternative options.
What to do if your request for recognition is denied from the Ministry of health
If you are still determined to work in healthcare in Italy, there are ultimately 2 other options in my opinion:
- In Italy there are 2 ways of getting a nursing degree recognized if you already have one from a non-EU country: apply for recognition through the Ministry of health (as I discussed above) or apply through a university. The university option for nursing is not technically a recognition of a foreign degree, it is actually just a simplified version for obtaining a new degree from that specific institution.
In this case you have to start from scratch: you must study for the entrance exam for health professions (“professioni sanitarie”) at applicable universities in the city you would like to study, get accepted, and start the 3 year nursing program. Once you are in, you will have the option to apply for degree/course recognition from the university while technically participating in all the classes. During the first year, your university will decide whether to recognize all or part of your previous education and possibly require you to take a language proficiency exam. Note that if you are accepted into a 3 year program, no matter how much coursework they will recognize, you will still only be able to graduate after the established three years. In other words, you are accepted into a class and you will be allowed to graduate only with that same class.
- You could become a consultant or clinical expert for a company that needs healthcare professionals to assist them with their services. For example, companies that work in: medical devices, pharmaceuticals, research, healthcare services for foreigners, electronic medical records, health journals, child care, international health conferences, etc..
This option will require a lot of initiative on your part, but I assure you that eventually you will find something.
The road I took..
While waiting 2-3 years for the verdict on my nursing degree recognition, it was important for me to continue working, so I applied to all the companies I could find that had a foundation in healthcare. I will not get into the specifics, but in 5 years I went through 3 jobs:
- Doing consulting for a pediatric clinic that was looking for an English speaker to assist with expanding their foreign clientele services
- Assisting with editing of an international gastroenterology journal based here in Milan
- Clinical analyst for a major company that does electronic medical records for Italian hospitals. This is where I spent most of those years.
I learned a lot from each of those jobs, especially because I knew nothing about the Italian healthcare system. They offered me the chance to learn something new while getting my bearings in this new country. But let’s be honest, if you chose to become a nurse it is because you love working with people, and that is something I missed dearly.
At one point however, a few coinciding situations encouraged me to take a leap: the final rejection from the Ministry of Health, the COVID pandemic, and maternity leave for my newborn son. All these happened at around the same time, and I thought what better moment than that to change course and do what I have always wanted to do: become a midwife. There are a few reasons I chose this path:
- I have always loved women’s health. In fact that is how I started in NP school, but then I changed to family health because of the versatility. I now had the opportunity to pursue it.
- The midwifery and nursing programs in Italy are very similar, in fact they are both considered 3 year “Professioni Sanitarie” programs that have the same entrance exam. This exam definitely requires some studying, especially if you haven’t brushed up on your basic sciences in a while. The Professioni Sanitarie are all the programs that include: nursing, pediatric nursing, midwifery, dietitian, physical therapy, and a few others. The good thing is that since the exam is the same, you can often apply to up to 3 programs in your order of preference so that if you don’t get into your first choice you have back-ups available.
- One of my biggest concerns about becoming a nurse in Italy is the fact that it is not a highly valued profession as it is in the US, and as a nurse practitioner, I personally struggle with the absence of professional autonomy. Midwives are considered and autonomous profession in Italy, and there is much more flexibility with the job prospects, so this was also a big incentive
So in the end, I took advantage of my maternity leave to study for the entrance exam a few months and fortunately I got into a program here in Milan. Once I was in, I started classes and submitted documents from my previous education to get recognition. The school did in fact recognize a huge majority of courses for my first year as well as some for the second and third year. As I said before, no matter how much gets recognized, you still have to put in the time to graduate with the class you started out with, so I am now finishing up my first year and expect to graduate in 2023.
I am surprised that there isn’t much practical information out there on this topic, so I am more than happy to update and integrate this post with any feedback.
If you have any experience with getting your nursing degree recognized in Italy, please feel free to share your experience and observations here, I am sure there are many people who would like to hear from you too!