Let's cook.
Bring a large pot of salted water to a boil for the pasta.
Heat 1 tablespoon of olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 6-8 minutes. Drain any excess fat.
Add the chopped onion to the skillet and cook until softened, about 5 minutes. Stir in the minced garlic and cook for 1 minute more until fragrant.
Pour in the crushed tomatoes, heavy cream, salt, and black pepper. Bring the sauce to a simmer, then reduce heat to low and let it gently cook while the pasta cooks.
Add the orecchiette pasta to the boiling water and cook according to package directions until al dente, typically 10-12 minutes.
Drain the pasta, reserving 0.5 cup of the pasta water.
Add the cooked orecchiette directly to the sauce in the skillet. Stir well to combine, adding a splash of reserved pasta water if the sauce is too thick.
Serve immediately, garnished with fresh chopped parsley.
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