Nursing work in Northern Italy during COVID, lack of organization

Interfaced
1

Introduction

B. is a male nurse working in the emergency department of the hospital of Carate Brianza (ASST Brianza), in Lombardy. During the COVID-19 pandemic, he experienced the emergency firsthand in the context of a medium-to-small emergency department, characterized by limited resources, including the absence of an intensive care unit and some specialized wards. His account reflects the everyday difficulties faced by healthcare workers during a period marked by great uncertainty, organizational chaos, and a lack of clear guidelines, as well as the human and psychological impact on the team and on the nursing profession in Lombardy.

I’d like to ask you about how you experienced the COVID-19 period, especially in relation to your work, which was particularly delicate. What were the main challenges, and how did you organize yourself, both individually and together with your colleagues, to try to cope with the situation?

2

From an organizational point of view, if we start there, everything was a process in the making. We found ourselves fighting, because it really was a fight, against something that no one knew. Every day we tried to improve and to manage situations as well as possible, but there was a great deal of confusion.

The confusion came from the fact that every possible level, Hospital Management, Medical Management, the Region, the State, was issuing or trying to issue guidelines for everyone. In reality, though, it remained complete chaos, because the guidelines were often unclear and frequently did not align with each other. On top of that, all of these indications had to be applied within systems that are not the same across hospitals.

I’m talking about my hospital, which is a small emergency department in Carate Brianza. It cannot be compared to larger hospitals. For example, we don’t have an intensive care unit, and we lack many wards that would allow better patient management. Yet we inevitably also had to deal with those patients, because they arrived by ambulance. If the emergency medical service could filter, they tried not to send that kind of patient to us, but patients also arrived on foot, including critically ill ones that we still had to manage as best we could, with all the difficulties involved.

It was a hard period. Many colleagues, especially those with more years of experience and different career perspectives, left during that time. Fortunately, I didn’t lose colleagues to COVID itself, and from a psychological point of view I consider myself lucky. But many colleagues were absent either during COVID or afterward. That was something I regretted, especially when people changed wards.

I started my career in the emergency department in 2017, and some of the people I considered points of reference there were lost during that period. Even today, when I meet them again, they thank me for having brought a bit of calm into the emergency department during such a hard time. A joke, a laugh, in those situations helped lift morale a little.

These are the two aspects that, in my view, marked that period the most, in addition to the human aspect, which was obviously very significant.

3

Did the dynamics that unfolded during that period leave a mark afterward? In the months and years that followed, when things settled a bit, did they leave you with something? Did they change how work was managed or organized?

4

Yes, something did change, in the sense that, from a respiratory care perspective, and I’m always talking about our small reality, for a certain period we found ourselves much more prepared. But like with everything, if you don’t repeat an exercise every day, over time you lose it. So for a while there was a lot of attention, even from hospital management, to some issues and aspects that had caught us unprepared.

But already now it feels like some of those things have been forgotten, as if nothing had happened. Not by chance, we had asked to be prepared in this period for pneumonia and influenza A and B, which here are once again bringing the emergency departments in the area to their knees because of overcrowding. We asked hospital management for a strategic plan to have more doctors, more staff, more resources. Nothing arrived, except “we’ll see how it goes.”

So once again, they preferred to wait until problems arise in order to manage them. That makes it clear that there isn’t really a will, or an approach, aimed at anticipating problems. But this is our public healthcare system today.

5

And among yourselves, in terms of organization and roles, did you become more united as colleagues, or less?

6

No, it didn’t change much. We were already a good group, and we worked well together. If anything, during COVID I noticed that we all became a bit more selfish, more focused on looking after our own well-being before that of others. I see this in general, among colleagues, at work, and in society more broadly.

Before, we were perhaps more willing to give, because life felt long. COVID scared us, and in my view it triggered something in many people, first in me and then in others. During that period, people were saying that afterward we would all come out better. I’m exaggerating, but there were applauses, praises, “great job,” “super nurses,” “we couldn’t do without you,” pats on the back.

But just look at now. It’s 2026. They’ve only just started talking about contracts and so on. “You’re number one, nurses, thank you for everything.” And what arrived? Less money than before, more working hours, less staff than before. So yes, pats on the back. We didn’t learn anything.

No, absolutely not. It’s no coincidence that now we’re recruiting nurses from abroad. We run discouraging campaigns around what it means to be a nurse in Italy, and even today everything comes up empty. Job competitions fail, university programs have fewer and fewer students. If someone has to study, they choose something that can offer a better future.

If today I could, if I didn’t have two children, a wife, a mortgage, and all the other commitments, I would have changed jobs. I’ve thought about it many times. At the same time, where I am now I feel okay, I have to be honest. I think I have a good capacity to adapt. I’ve been there for almost ten years, and in a way, excuse the term, I’m considered a veteran. I can manage myself and also help manage others. But yes, changing jobs is something I’ve thought about more than once.

7

Of course, I can imagine. It was a painful chapter for Lombardy and for Italy more broadly. During the COVID period, there was, I’ll put it a bit clumsily just to explain the idea, some kind of reshuffling of roles. I don’t mean contracts, but rather whether someone emerged as a leader, or whether there was some kind of hybridization.

8

No, I didn’t perceive that. Also because those who might have emerged as leaders chose to go elsewhere. In the sense that some people managed to build connections during that period with people in management or leadership positions, and when they had the chance to stand out or seize the moment, they decided to leave.

Within our own setting, I didn’t see anyone stand out in a way that was different from how they had already been. No, I didn’t perceive that kind of change.

9

So basically, people either stayed where they were, or they left?

10

No, the situation disintegrated.

11

So that aspect actually worsened?

12

In my view COVID did not bring improvements of any kind within hospital environments. It’s obvious. You can see it everywhere.

13

But despite that difficult period and the tensions it created, as nurses you don’t feel more organized after COVID, in practice?

14

No, because the lack of staff is still there, and the contracts are still terrible.

15

But haven’t you been able to protest? Didn’t it change the way you act?

16

No, there is no protest. I went once with the union to the Monza Duomo square during a pre-contract protest and similar initiatives.

I had never taken part in protests before, not because of the cause, but because of the way they were done. When I, as a nurse, decide to go protest in a square for one of my rights, and at the same time my colleagues keep working and the system keeps running as if nothing were happening, I’m just wasting my time.

And I’m also losing a workday. So these are protests that are pointless. I repeat, I went to the Duomo, there were eight of us plus a few others, but they were basically just extras.

17

Key concepts developed from the material:

  1. “Responsibility without agency” – being held responsible without the power to act; central to the nurse’s experience, but stands in contrast to the priest, who held significant institutional agency during the crisis. Together they illustrate how power and responsibility are unevenly distributed across civic and institutional actors.

  2. “Devolution without resources” – institutional responsibility is pushed downward while power stays at the top

  3. “Broken moral economy of care” – societal promises (“super nurses”, applause) were never fulfilled

  4. “Structural disillusionment as a barrier to civic participation” – not apathy, but rational resignation as a response to structural powerlessness

The thread connecting them: Together these concepts help explain why democratic and civic participation fails in this context – not due to lack of will, but due to accumulated structural experience.