Heat a large skillet over medium-high heat. Add the sausage; sauté for 6 minutes, stirring to crumble. Remove the sausage from pan.
Bring the water, cream, and butter to a boil in a medium saucepan over medium heat; reduce heat to low. Gradually add the polenta, stirring with a whisk and cook until thick, 3 minutes, stirring constantly. Top with the crumbled sausage. Sprinkle with the pepper and parsley if using.