Bring a large pot of salted water to a boil. Add the fettuccine and cook according to package instructions until al dente.

Drain the pasta in a colander and set aside, reserving 1/2 cup of pasta water.

In a large skillet, heat the olive oil and 2 tablespoons of butter over medium heat.

Add the sliced sausage and cook until browned and cooked through, about 8-10 minutes.

Add the minced garlic and cook for an additional 1-2 minutes until fragrant.

Reduce the heat to low and add the heavy cream to the skillet with the sausage. Stir to combine.

Gradually add the grated Parmesan cheese, stirring until melted and smooth. If the sauce is too thick, add reserved pasta water a little at a time until desired consistency is reached.

Season with salt and black pepper to taste.

Add the cooked fettuccine to the skillet and toss to coat in the creamy sauce.

Serve hot, garnished with chopped parsley and additional Parmesan if desired.