In a large pot of boiling salted water, cook gnocchi until al dente according to package instructions. Drain.
Meanwhile, in a large skillet over medium heat, heat 1 tablespoon oil. Add sausage and cook until seared and just cooked through, about 8 minutes. Transfer to a cutting board.
Wipe skillet clean. In the same skillet over medium heat, heat remaining 2 tablespoons oil. Add garlic and cook until fragrant, about 1 minute. Add sage and tomato paste; stir to combine. Whisk in broth and pumpkin puree; season with salt and pepper. Bring to a boil, then reduce heat and simmer until slightly thickened, about 5 minutes.
Slice sausage into coins and return to skillet along with gnocchi. Stir in Parmesan and cream; cook until gnocchi is coated in sauce, about 2 minutes.
Stir in nutmeg; season with salt and pepper. Top with Parmesan, parsley, and a few grinds of pepper. Serve and enjoy!