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Bring a large pot of heavily salted water to a boil over high heat.
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Meanwhile, heat the oil in a large frying pan over medium-high heat until shimmering.
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Add the sausage and cook, breaking up the meat into smaller pieces with a wooden spoon, until it’s no longer pink and is starting to brown, about 6 to 8 minutes.
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Remove with a slotted spoon to a large bowl and set aside.
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Reduce the heat to medium, add the onions, and season with salt and pepper. Cook, stirring occasionally, until the onions have softened and are just starting to brown, about 6 minutes. Turn off the heat.
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When the water is boiling, add the broccoli and cook until crisp-tender, about 3 minutes. Using the slotted spoon, transfer the broccoli to the bowl with the sausage.
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Return the water to a boil, add the pasta, and cook according to the package directions or until al dente. Reserve 1/2 cup of the pasta water, drain, and return the pasta to the pot; set aside.
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Return the pan of onions to medium heat, add the cream, and stir, scraping up any browned bits from the bottom of the pan. Bring to a simmer and cook until slightly thickened, about 2 to 3 minutes. Add the sausage and broccoli and stir until combined.
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Pour the broccoli-sausage mixture over the pasta, add the measured Parmesan and reserved pasta water, and stir to combine. Taste and season with salt and pepper as needed.
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Serve immediately, passing more Parmesan on the side.
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