1955 – The birth of the Colleges
It is 1955. Italians are trying to forget their memories of the war and even if still unaware of it, they are getting ready for the booming years. It is in this climate that the Colleges of professional nurses, children’s nurses and health visitors, are established by the Governmental Decree of October 1954. The Colleges were established above all thanks to those ladies working in the health sector who became aware that they had become precious, but were still not professionally recognized, since the 1946 decree on the health professions only restored the Orders of Surgeons, Veterinarians and Pharmacists and introduced the Colleges of Midwives. However, from then on, the Colleges and the IPASVI Federation have continuously developed, recording all the stages of their growth and changes where nursing has been the main protagonist. The first important step was to convince nurses, children’s nurses, health visitors, both religious and lay people, to enroll in their respective registers. The data collected in 1959, on the occasion of the national census of the healthcare service providers, showed that good results had been achieved, but there were still some difficulties.
1960 – The first Code of Ethics is born
On February 15, 1959, the Central Committee of the Ipasvi Federation began to discuss the need to draw up a Code of Nursing Ethics, indicating the ethical principles in relation to which the members of the profession should operate. The first Code of Ethics for Italian nurses was issued the following year, in 1960. An important achievement that represented a step forward in the construction of professional identity, especially in the relationships with other health professions.
However, a few years later there was a need to revise the text with the aim of eliminating what was too “linked to time, to transient historical and social issues”, as stated in the presentation of the new Code. In substance, it was a matter of withdrawing references that were too old-fashioned, strident with a new nursing generation not extraneous to the social turmoil that was going on in those years, not just in our country, but throughout the world.
1965 – Nurses meet for their Congress
More well-being, more mobility for the country, also thanks to the spread of cars. So eventually the Federation of Ipasvi Colleges can call its first National Congress, held in Rome from May 31 to June 2, 1965.
The venue chosen for the opening ceremony was the Palazzo degli Uffici, in the most modern district of Rome, called EUR, where all the “top religious, military and civil authorities” were present, as the papers in those days reported.
Even if the pictures seem to show us a very rigid and formal reality, the opening speech of the then president Laura SterbiniGaviglio was not at all ritualistic: by retracing the stages of the ten years of life of the Colleges, she underlined all the difficulties the profession had to face, from the lack of State free schools, to the problems of contractual framing, to the more general defence of the dignity of the nursing profession, concluding with the affirmation of being by then in a “time ripe to achieve a social security system.
1971 – Make way for men!
“Extension of the exercise of professional nursing to male staff”: this is how Law no. 124 of 25 February 1971, which establishes a real revolution in the world of nursing, reads. The history of the profession had been up to this point an exclusive prerogative of women: a saint to protect them, the matron Fabiola who dedicated herself to care in ancient Rome, a woman as an ideal model, Florence Nightingale, and then many other women in hospitals, in hygiene visits to the most difficult areas of the country, in child care. Nursing, regarded as “auxiliary” and “vocational”, was considered particularly suitable for women and especially for nuns, who for many years accounted for the majority of the nursing staff. This situation produced, as a consequence perhaps unwanted, the curious “anticipation” of a female frontrunning even in leading positions, for example the two nursing representatives called, by right, in 1957 to join the Superior Council of Health. But the development of society progressively led to a radical transformation of the role of nurses, who acquired more and more competence and professional autonomy.
Therefore, also for the sake of social equity, the profession could no longer be precluded to men, who, moreover, were already allowed to act as generic nurses. It was precisely on the distinction between professional nurses and generic nurses that a difficult debate was opened between the legislators, interested in recruiting staff, and the Ipasvi Colleges, concerned about the protection of a professional qualification acquired through many years of study). The introduction of men in professional roles also accelerated the change in training curricula, starting with the boarding schools, which had to derogate from the internship for male students.
1973 – European standard education
Italy implements the European Agreement on the Education and Training of Professional Nurses (Law No 795 of 15 November 1973). This is an important step in the history of nursing: the document will be the benchmark for the entire process of regulatory reorganization that will develop from the seventies to the present day.
The Strasbourg Agreement sets out the essential points for a revision of the curricula and defines the educational function of the practical traineeship of the students. In order to comply with the European guidelines, which provide for 4600 hours of teaching, new curricula will be drawn up and the length of the courses will be increased from two to three years. The aim is twofold: to improve the quality of training and to allow nurses to work in each of the countries signatory to the Agreement
1974 – Tasks renewed
In 1974, the field of activities and skills of nurses was defined by the DPR 225, the so-called “Mansionario” (job description), which modified the former rules governing the profession, dating back to 1940.
The reform of the health service, which was to come into being in 1978 with the approval of Law 833, was preceded by a long preparatory period during which the activities of the health professions were reorganized.On the whole, the “new” job description was welcomed by the representative bodies of the profession which, while underlining some of its contradictions, at the time of issue considered it an important step in the evolutionary process of nursing. The text intended to establish a different approach to the patient, no longer seen only as a sick with clinical problems, but as an individualexpressing psychological, physical and social needs.By this logic, the relational aspects of nursing became crucial, and its functions were enhanced, as highlighted by the same wording of the DPR. For example, the term “to carry out“, present in the previous normative dictates, is almost always amended with “to plan” and “to promote … initiatives“. Moreover, the term “to coordinate” was introduced while “to depend” was suppressed. The job description broadened the scope of nursing activities from the hospital to public health services and covered the areas of prevention, treatment, rehabilitation and health care. The pedagogical role of the nurse in relation to the patient and his/her family, but also to other staff and students, was also recognized.In short, with the DPR 225 nurses acquired a professional profile more appropriate for the times, which reflected the recognition of a certain operational autonomy and clear responsibilities for activities identified by the legislator as being specific: a list bound, however, to age very soon in the impact with the transformations driven by scientific and technological progress.
1977 – The second Code of Ethics for nurses
The Code of Ethics issued in 1977 is a concise, lean text, but not lacking in major underpinnings: “the nurse facilitates the human and social relations of the patient”, “the nurse, in full respect of the rights of the patient, avails himself of his trade union rights”, “the nurse has the duty to qualify and update his training”. One can read the profile of a professional who certainly does not give up the human dimension of care, but enriches it in a social perspective, combining it with an affirmation of dignity of the category ranging from trade union defenses to the need for technical and scientific updating.
This Code will remain in use for many years, without the need of being reviewed, probably thanks to the extreme synthesis of its formulation.
1978 – No longer health insurance funds. The National Health Service was born.
It was in 1978, ten days before Christmas, that the Prime Minister Giulio Andreotti, the Health Minister Tina Anselmi, a vast parliamentary group, that in those times had only be seen for the election of Ciampi as President of the Republic, after years of debates and clashes, agreed to establishing a public national health service. The only votes against were those of the Social Movement and the Liberal Party with the abstention of the Republicans (in total less than 15% of the voters).With an almost plebiscite majority, therefore, Italy also joined the club of those countries that had chosen to have a national system of health protection by placing the prevention, treatment and rehabilitation of diseases among the first tasks of the Republic.The old health insurance funds, characterized by obvious inequalities between the different categories of beneficiaries, left the place to the Local Health Units (USL), which took over all the responsibilities for health care.The funding of the system was to be provided by general taxation (but it would take almost two decades before the old sickness contributions were actually taxed) and a National Health Fund was set up, which became part of a special expenditure chapter of the Ministry of the Treasury. The 1978 reform has been the object of many measures of modification and integration, culminating in the first major reform of the reform (that of the two-year period 1992/93) which transformed the Local Health Units into “Local Health Authorities” with legal autonomy giving rise to the so-called “corporatization” of the system. The “ter reform” (better known as the Bindi reform by the Minister of Health who devised it) was launched in 1999, but is still largely unimplemented, mainly because of the change of majority following the 2001 general elections and the simultaneous launch of the federalist reform of the State, which further strengthened the role of the Regions in the governance of health care.
1992 – The arrival of the University Diplomas
In the academic year 1992/93, about one thousand students crossed the threshold of the University to attend the university diploma courses for nurses, started in 18 Italian universities. The transition of training to the University was the culmination of a decade of battles carried out by the whole profession to adapt the training courses to the role of great responsibility played by nurses in every structure of the Italian health system and to enter Europe by full right.This need is fully integrated into the overall plan of reform of the University, launched in 1990, which also established in our country the bachelor degrees. At the end of 1992, Legislative Decree 502 (later 517) was issued.This Decree,besides defining the competences of the University, the Regions and the ASLs of the NHS as far as nursing education is concerned, sets as a condition for access to nursing schools the requirement of a five-year upper secondary school-leaving certificate. The new rule aims to safeguard the heritage of educational experience of previous schools, providing for the accreditation of suitable centers by the University. In 1996/97, the transitional period of the new training system ended with the permanent handover of all basic training to university. Since then, the diploma, next to the signature of the Head of the course, bears that of the university Dean.
1994 – A great public demonstration
On July 1, 1994, 50,000 health workers paraded through the streets of Rome, most of them professional nurses. It was a demonstration to ask for more attention for the public health system, in years when privatization seemed to be the solution to every problem, and above all interventions for a better qualification of the health professions, that is the new professional profiles that had been under discussion for a long time but that were late in approval.But the long Roman parade also represented a crucial moment for the development of a new and stronger professional identity: banners, posters, thousands of balloons showed everyone that modern nurses were distant and different from the stereotypes of the past. All the slogans were centered on this awareness: “Qualified nurse, safeguarded patient”, “We want to improve in order to help and care”, and also, in an ironic but not groundless controversy: “Mr. Doctor I committed a great crime, I thought, I thought!”. Without forgetting the immediate objectives: “Costa, Costa, we want an answer”. And the answer arrived promptly. A few months later, in September, the then Minister of Health Raffaele Costa signed the ministerial decree defining the role and functions of professional nurses.
1994 – Nurses have a new profile
The professionalprofileis the milestone in the process of professionalizing nursing. MinisterialDecree 739/94 recognizes the nurse asresponsible for general nursing care, specifies the nature of hisinterventions, the operational fields, the work methodology, the interrelationships with otherprofessionals, the professional fields of cultural and operational study, the fiveareas of specialist training (public health, pediatric area, mentalhealth / psychiatry, geriatrics, critical area). The profiledrawn by the decreeisthat of an intellectualprofessional, competent, autonomous and accountable. A similardefinition of the fields of activity and competenceswill be subsequently set for the paediatric nurses (Dm 70/97) and for 20 otherprofessionals, includinghealthvisitors, midwives, rehabilitationtherapists, laboratorytechnicians and so on. The implementation of the profileisintendedas a test bench to verify the consistencybetween the aspirations and potential of nurses, who are calledupon to assume – evenformally – the responsibility of autonomouslymanaging the care process, from decision-making to implementation, evaluation and assessment.
1996 – The Agreement between nurse and citizen
The Agreement is a quite innovative tool that gives space to the growing need for the profession to play a leading role autonomously, addressing the natural interlocutor of its activities. This is a real challenge, which frames nursing in a social dimension wider than the boundaries of health care facilities, proposing a “commitment” without any mediation between the real actors of care, that is, the nurse and the citizen.
1999 – Neveragain “auxiliary”.
No longer an “auxiliary health profession”. At last, this anachronistic and improper definition attributed to nurses was definitively cancelled by a State law. Law 42/99 (Provisions on health professions) provides that the field of activity and responsibility of the nursing profession is determined by the contents of the decree establishing the profile, by the educational systems of the respective university diploma courses and post-basic training, as well as by the deontological codes that the profession gives itself.
1999 – The third Code of Conductarrives
In line with the 1996 Agreement, a rewriting of the Nursing Code of Ethics wasachieved and launched on onMay 12th 1999, International Nurses’ Day. The aim of the new Code is to outline the characteristics of the nursing mission in order to givespace to the needs of professionalautonomy and providing a trace of reflection for the daily interaction amongprofessionals and the delays of the culture and structures in whichthey operate.
2000 –Master’s degree and management
The last steps in the process of reorganization of the profession are set by Law 251/2000 (Regulation of the nursing, technical, rehabilitation and midwiferyhealthprofessions). Thislawprovidesthat nurses in possession of the diplomasissued under the previous systems can access the second level degree in Nursing Sciences. Thus, after a long struggle of the Ipasvi Federation, the principle of the equipolence of the titles for the purpose of continuingeducationpasses. But the mainrelevance of Law 251 lies in the “formal” recognition of leadership: for nurses, the doors are thusopened to access the new uniquequalification of manager of the healthrole. Pending the entry into force of specificenrolling rules, transitionalprovisionsestablishthathealthorganizations can stillproceed to the assignment of the posts of director of nursing and midwifery services “through a suitableselection procedure amongcandidates with pre-determinedrequirements of experience and professionalqualification. Thesefigures are responsible for and manage nursing care activities and relatedfunctions, aswellasreviewinglabourorganization by encouraging models of tailored care.
2001 – Degrees in harmony with Europe
The decrees of April 2nd, 2001 on the determination of the degree classes for the healthprofessions are part of the general process of reform of the University, whichproceeds to align with the European scenario: the university diploma courses for nurses are thustransformedinto a three-year degree and isprovided for the master’s degree in nursing and midwifery sciences, which can be accessed on the basis of credits acquired in basic training.
In the specific class of degree reserved to the nursing and midwiferyhealthprofessions are included the profiles of the nurse, midwife and paediatric nurse.
2002 – A law to stem the emergency
2002 began with the enactment of a law concerning nurses, no. 1 of 8 January (Conversion into law, with amendments to Decree Law no. 402 of 12 November 2001, containing urgent provisions on health personnel). The measure, introduced to address nursing shortage, actually set out some more general principles:
- recognized the possibility for nurses employed by the NHS to carry out private practice within the facilities of their Administration to ensure through “additional work … the standards of care in wards and the activities of the operating theatres;
- provided for the possibility of re-entering the service to nurses who had voluntarily resolved their contractual relationship by stipulating fixed-term contracts;
- defined the tasks of the social healthcare worker, underlining that this worker carries out his activities “under the directions or the supervision of the nurse or midwife in charge”;
- enhanced the complementary training and valued for career purposes Masters and other post-basic courses.
2004 – Specialist Degrees are on the way
By decree of 9 July 2004, the Ministry of Educationestablishes the terms and contents of admissiontests to master’s degree courses in Nursing Sciences and by decree of 27 Julydefines the number of places for enrollment. On 1 October, with a furtherdecree, itrecognizes for the purposes of admission “as an exception to passing the due test” the position of nurses already in possession of the qualificationsissued by Special Schools and holders, for atleasttwoyears, of the post of Director of Nursing Services or of Director or Coordinator of Degree Courses.
Thus, in the 2004-2005 academicyear, the specialist degree finallybecame a concrete reality and the coursesstarted in 15 Italianuniversities.
Thisis an objectivethat the Federation and the Ipasvi Colleges pursued with perseverance, with the aim of offering nurses the possibility of undertakingincreasinglycomplex and diversified curricula, making themactive and competentprotagonists of a rapidlydevelopinghealthcare world.
The specialist (or master’s) degree isnot a compulsory training stage, but an opportunity for nurses whowish to acquire the professionallevelneeded to fulfilspecific positions in the advancedclinical-assistance area, in management, training and research.
2006 – The first PhD Courses in Nursing 2006 – The first doctorates begin
The first PhDs in Nursing Sciences start: this is the stage that fills the academic path of the nursing profession in our country.
The achievement of this important goal is due to the sensitivity of some prestigious universities, but also to the support of the National Federation of Ipasvi Colleges, which, in the final phase, granted some scholarships.
The first call to be published was that of the Roman University of Tor Vergata, to which soon later the Florence one followed.
2009 – The new Nursing Code of Conductisratified
The need to redefine the documentreflects the evolution of the profession, which over a decade hasacquired an identityfinallyclear and defined in its scope. The nurse is no longer “the health care provider” with an enabling diploma, but “the health care professionalresponsible for nursing care”. A practitionerwho, assuch and also in hisindividuality, supports the individual and the community through the nursing act, intendedas the overall knowledge, prerogatives, activities, skills and responsibilities of the nurse in allprofessionalareas and in different care settings.
From thissignificantturning point originates the “new” nurse-person/client relationshipimplemented by the Code of Ethics for Nurses 2009.
2015 – With the implementation of Directive 2013/55/EU comes the European Professional Card (EPC)
The legislative decreetransposing Directive 2013/55/EU introduces the European Professional Card, whichprimarilyconcernsfiveregulatedprofessions, including nurses.
The text states the competencesthat the EU legislationprovides for nurses and the Legislative Decreereads:
“The qualification of nurse responsible for general care certifies the ability of the professionalconcerned to applyatleast the following competences, regardless of whether the training took place in universities, in highereducation institutions of a levelrecognisedasequivalent or in vocational schools or as part of vocational nursing training programmes:
- the competence to independentlyidentify the necessary nursing care usingcurrenttheoretical and clinical knowledge and to plan, organise and deliver nursing care in the treatment of patients, on the basis of the knowledge and skills acquired, with a view to improvingprofessionalpractice;
- the ability to work effectively with otherhealthprofessionals, includingparticipation in practical training of healthprofessionals on the basis of the knowledge and skills acquired;
- the competence to steerindividuals, families and communities towardshealthy lifestyles and self-care, based on the knowledge and skills acquired in accordance with points (a) and (b) of paragraph 6;
- the competence to initiate immediate life-support measuresindependently and to intervene in crisis and disaster situations;
- the competence to provideautonomousadvice, guidance and support to personsneeding care and their support persons;
- the competence to independentlyguarantee the quality of nursing care and to assessit;
- the competence to communicatethoroughly and professionally and to cooperate with members of otherhealth care professions;
2017 – New responsibility for nurses and healthprofessions
With the approval of the law 24/2017 “Provisions on the safety of care and the assistedperson, aswellas on the professional accountability of healthprofessionals” itwaspossible to acknowledge for the first time the crosscutting nature of the relevance of the tasks and actions of allprofessionsinvolved in care and in meeting the patients’ needs. Itsprinciplesconcern best clinical and care practices and the recommendations of the guidelines to be followed in order to avoidincurringresponsibilityprofiles. Thesewill be developed by institutions, scientific societies, butalso by technical-scientificassociations of healthprofessionals. Then, the court must alwaysentrust the consultation and appraisal to a panel consisting of a forensicphysicianbutalso of one or more experts with specific and practical knowledge of the subject-matter. Allhealthprofessionals are eligible for appointmentas office technical advisors (CTU)
2018 – The WHO Executive Board designates the year 2020 as the “Year of the Nurse and midwife”, and launches the Nursing Now campaign
A new global campaign, Nursing Now, was launched by the World Health Organization on 27 February 2018 to empower and support nurses in addressing the health challenges of the 21st century.
In collaboration with the World Health Organisation and the International Council of Nurses, Nursing Now aims to improve the status and profile of nursing and to enable nurses to meet the health challenges of the 21st century.
Nursing Now will last until the end of 2020, the 200th anniversary of Florence Nightingale’s birth, when nurses will be celebrated globally for the first time with a year devoted to them.
The aim is to improve nurses’ awareness, enhance their influence and maximise their contribution to ensuring universal heath coverage.
2018 – From “College” to “Order”
The Law of 11 January 2018 (Law Lorenzin), which came into force on 15 February of the same year, established the National Federation of Orders of Nursing Professions (FNOPI). At the provincial/interprovincial level, operate the nursing professions orders (OPI), which only include the nurses and paediatric nurses (former child care workers).
Health Visitors are hived off and enter the National Federation of Medical Radiology Technicians and Technical Health Professions for Rehabilitation and Prevention.
This is an important transition insofar as the College was a simple auxiliary body of the State while the Order operates as a subsidiary body of the State and can therefore carry out administrative tasks in place and on behalf of the State.
2019 – It is time for the fifth Code of Ethics for nurses, the first in the era of professional orders
The rules of the nursing profession are updated: in 2019, ten years after the 2009 Code, the guidance of the profession turns modern and adapts to times as times are gradually adapting to the profession and the professionalism of nurses. Its characteristics are utmost transparency and sharing, it is a guiding criterion for the professional practice of the nurse that must take into account its evolution both from the legal point of view and the status and professional skills.
Today, the nurse is a health professional to whom every citizen turns in a direct relationship, trusting in the opportunity to receive professional, relevant and personalized care.
The new Code of Ethics 2019 is a tool for nurses to express their competence and humanity, their ability to treat and care.