The Community Nurse in Italian Model: A Systematic Review

Abstract

The increasing burden of chronic diseases, population ageing, multimorbidity, social vulnerability and the need to strengthen primary health care have renewed interest in community-based nursing models. In Italy, this process has led to the formal introduction of the Infermiere di Famiglia o Comunità (Family and Community Nurse, FCN), a professional role designed to ensure proactive, integrated and proximity-based care across individual, family and community settings. This review aims to synthesize current evidence on the role, expertise and implementation of the Family and Community Nurse in Italy, with particular attention to competencies, organizational models, policy development and barriers to implementation.
A systematic search was conducted in using PubMed/MEDLINE, Google Scholar, institutional repositories and official Italian and international policy sources. Search terms included “family and community nurse”, “community nurse”, “Italy”, “primary care”, “competencies”, “implementation”, “DM 77/2022”, and “PNRR”. Peer-reviewed articles, systematic and scoping reviews, qualitative studies, policy documents and institutional guidelines published between 2000 and 2026 were considered. Due to the heterogeneity of study designs and outcomes, findings were synthesized narratively.
The evidence shows that the Italian FCN is a strategic figure for the transition from hospital-centred care to community-oriented primary care. Core functions include health promotion, prevention, early identification of health and social needs, chronic disease management, therapeutic education, care coordination, caregiver support, population health management and activation of formal and informal community resources. The role requires advanced clinical, relational, educational, epidemiological, digital and leadership competencies. National policy has progressively strengthened the FCN framework, particularly through the COVID-19 emergency legislation, the National Recovery and Resilience Plan and Ministerial Decree 77/2022, which defined the standard of one FCN per 3,000 inhabitants. However, implementation remains uneven across Italian regions, with persistent barriers related to role ambiguity, workforce shortages, limited public awareness, variable training pathways, fragmented governance and insufficient outcome evaluation.
The Family and Community Nurse represents a pivotal professional resource for integrated primary care in Italy. To move from policy recognition to effective implementation, Italy needs clearer role boundaries, standardized postgraduate education, stable workforce planning, digital infrastructure, interprofessional governance and robust indicators to evaluate impact on access, continuity of care, hospital use, patient empowerment and health equity.