Heat a large skillet or Dutch oven over medium heat. Add the Italian sausage and cook for a couple of minutes, breaking it apart with a wooden spoon as it cooks. Then add the carrots and cook for another 5 minutes, until the meat is browned and cooked through and the carrots are starting to soften.
If the sausage is very lean, add a small drizzle of olive oil to the pan.
Add the diced. Cook for 2-3 minutes, stirring occasionally, until the onion softens.
Stir in the tomato paste and cook for 1–2 minutes to deepen its flavor.
Add the minced garlic, Italian seasoning, dried parsley, garlic powder, and onion powder. Stir and cook for 30–60 seconds, until fragrant.
Pour in the broth and stir, scraping up any browned bits from the bottom of the pan.
Bring the mixture to a gentle boil, then stir in the uncooked gnocchi.
Reduce the heat slightly and cook for 2–3 minutes, stirring occasionally. The gnocchi should begin to become tender, but doesn't need to be completely cooked yet.
Reduce the heat to low and slowly stir in the heavy cream.
Add spinach and Parmesan cheese and stir until melted and incorporated into the sauce.
Continue to simmer gently for another 3–5 minutes, stirring occasionally, until the sauce thickens and the gnocchi is tender.
Don't let the sauce boil rapidly once the cream and Parmesan are added, as this can cause the sauce to separate.
Taste and season with additional salt and black pepper as needed. Keep in mind that the sausage, broth, and Parmesan can all contribute salt, so you may not need much additional salt.
Serve warm with extra freshly grated Parmesan and fresh parsley, if desired.