Shaping Italy’s Primary Health Care: are nursing students willing to join the change?

Abstract Background The ongoing reform of Primary Health Care (PHC) in Italy requires an adequate nursing workforce to support emerging models of PHC. This study investigates nursing students’ knowledge, attitudes, and willingness to work in PHC and Family and Community Nursing (FCN), identifying associated factors. Methods A cross-sectional study was conducted among nursing students at Sapienza University of Rome during the 2023-2024 academic year. A structured questionnaire, aligned with national PHC standards, was administered. A multivariable logistic regression model was used to identify predictors of low willingness to work in PHC. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results Among 273 students (77.7% female; mean age 22.9 ± 5.1), 34.8% were in their final year. Only 13.9% identified core PHC settings, and 63.4% described the FCN role. Only 6.6% of students had completed a PHC placement, while 73.6% expressed willingness to engage in one. Approximately one-third of the sample (37%) reported being willing to work in PHC after graduation. Main barriers were a preference for hospital work (52.3%). Multivariable logistic regression analysis identified that female gender was negatively associated with willingness to work in PHC (OR = 0.41; 95% CI: 0.21-0.79; p = 0.007). Conversely, having completed at least one PHC placement (OR = 4.05; 95% CI: 1.05-15.59; p = 0.042), willingness to undertake a PHC placement (OR = 6.60; 95% CI: 2.56-16.98; p < 0.001), and having adequate knowledge of FCHN core competencies (OR = 1.90; 95% CI: 1.03-3.50; p = 0.039) were positively associated with willingness to work in PHC. Age, marital status, geographic origin, and year of study were not significantly associated. Conclusions Although the evolving PHC models demand a strengthened nursing workforce, nursing students still show limited readiness to engage with the change. This study is part of the “Age-It” project, funded by Next Generation EU (PNRR, PE8). Key messages • Early and structured exposure to PHC settings during nursing education is a key driver of willingness to work in community care after graduation. • Universities play a strategic role in shaping the future PHC workforce by aligning nursing curricula with national health priorities and reforms.