Nurses have rejected the government's offer of a 5.5% pay rise, the Royal College of Nursing (RCN) has said.
Two thirds of RCN members in England voted against the current year's pay award, with a record high 145,000 members of the union casting a vote.
In a letter to Health Secretary Wes Streeting MP, RCN general secretary Professor Nicola Ranger said: "We are witnessing a fundamental shift in the determination of nursing staff to stand up for themselves, their patients and the NHS they believe in.
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"Many will support the new government's health and care agenda as set out in recent weeks and fully recognise the diagnosis of a failing NHS. Working closely with all other professionals, nursing staff are the lifeblood of the service. The government will find our continued support for the reforms key to their success."
Professor Ranger added: "To raise standards and reform the NHS, you need safe numbers and they need to feel valued. Nursing staff were asked to consider if, after more than a decade of neglect, they thought the pay award was a fair start.
"This outcome shows their expectations of government are far higher."
Nurses are worried, she said, about "understaffed shifts, poor patient care, and nursing careers trapped at the lowest pay grades."
The pay award was announced by Chancellor Rachel Reeves at the end of July, shortly after Labour won the general election.
The RCN said the high turnout surpassed the level seen in two statutory ballots for industrial action held by the union in 2022 and 2023, the first of which permitted six months of strike action by nursing staff.
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Last week, junior doctors voted to accept a multi-year pay rise to end their long-running dispute.
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Members of other health unions have accepted the 5.5% pay deal, which is for 2024/25.
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