The Royal College of Nursing (RCN) has threatened to ballot its members on industrial action if the government fails to reach an agreement on investment in the profession over the summer.
It comes after members of the union rejected a 3.6% pay increase for 2025/26 in England.
Nurses feel “deeply undervalued,” said Professor Nicola Ranger, general secretary and chief executive of the RCN.
The Department of Health and Social Care (DHSC) said the government “hugely” values the work of nurses, but stressed the profession has had “two above-inflation pay rises”.
Some 91% of RCN members voted to reject the pay award, with a 56% turnout.
The RCN warned the profession faces widespread vacancies, stunted career progression and years of pay erosion.
It urged ministers to use the summer to agree an investment plan or face a formal escalation to a dispute and a ballot on industrial action.
Prof Ranger said: “My profession feels deeply undervalued and that is why record numbers are telling the government to wake up, sense the urgency here and do what’s right by them and by patients.
“Record numbers have delivered this verdict on a broken system that holds back nursing pay and careers and hampers the NHS.
“As a safety-critical profession, keeping hold of experienced nursing staff is fundamentally a safety issue and key to the Government’s own vision for the NHS.
“Long-overdue reforms to nursing career progression and the NHS pay structure aren’t just about fairness and equity but are critical for patient safety.”
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Nurses in Wales and Northern Ireland consulted on the same pay award also voted to reject it, according to the RCN.
Prof Ranger added: “We deliver the vast majority of care in every service and deserve to be valued for all our skill, knowledge and experience.
“To avoid formal escalation, the government must be true to its word and negotiate on reforms of the outdated pay structure which traps nursing staff at the same band their entire career.”
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A DHSC spokesperson said: “After receiving two above-inflation pay rises from this government, new full-time nurses will earn £30,000 in basic pay for the first time this year, so it’s disappointing that RCN members are dissatisfied with this year’s pay rise.
“We hugely value the work of nurses, and through our 10 Year Health Plan, we are rebuilding the NHS for the benefit of patients and staff, and ensuring nursing remains an attractive career choice.
“This government is clear we can’t move any further on headline pay but will work with the RCN to improve their major concerns, including pay structure reform, concerns on career progression and wider working conditions.”
Nurses staged unprecedented industrial action over pay in 2022 and 2023, with the threat of more strikes ending in June 2023 because a ballot on further walkouts failed to meet the legal threshold of 50%.
It comes after a five-day walkout by resident doctors in England. Medics returned to work at 7am on Wednesday.
