[From emergency derogation to normalization of the exception: implications for the nursing profession in Italy]

. From emergency derogation to normalization of the exception: implications for the nursing profession in Italy. The Italian emergency provision allowing foreign-trained nurses to practice without prior formal recognition, introduced during the Covid-19 pandemic under Decree-Law 18/2020, has progressively evolved from a temporary measure into a structural workforce strategy. Under the ordinary pathway, foreign qualifications must undergo ministerial recognition, verification of substantial equivalence, language certification, and registration with the Provincial Nursing Board (OPI). The derogation reverses this sequence, permitting professional practice before or even without formal recognition, thereby shifting from preventive evaluation to ex-post control. While the measure ensures rapid recruitment and staffing flexibility, it raises concerns regarding patient safety, professional standards, and regulatory coherence. Variability in international nursing education, absence of compensatory measures, and limited language assessment may produce heterogeneous competencies.Available data indicate a marked increase in foreign nurse recruitment, with estimates suggesting that nearly 10% of the Italian nursing workforce is foreign-trained. However, transparency gaps remain regarding numbers, distribution, and long-term integration. Ethical implications extend globally, as large-scale recruitment from countries with their own workforce shortages risks contributing to health-sector brain drain.A sustainable response requires transparent monitoring, structured integration pathways, mentoring programs, and renewed investment in domestic workforce planning. Balancing openness with quality assurance is essential to safeguard patient safety, professional identity, and long-term health system sustainability.