Nurses have voted to reject the latest pay offer from DHBs around the country - and the nurses organisation says strike action is "likely".
An announcement on the New Zealand Nurses Organisation's website said national delegates would meet on April 18 to decide the next steps and bargaining strategies, including any recommendations for industrial action.
Members will then be balloted on whether to strike.
NZNO Industrial Services Manager Cee Payne said a majority of their members voted on this issue.
She said nurses were dealing with an ageing population and an increasingly sick population, which was leaving staff stressed.
"The issues we're dealing with have arisen from a decade of underfunding of the health system.
"Along with an increasing community need for healthcare, and ageing population, an ageing workforce, and rising costs in the delivery of healthcare.
"Our members have been reporting to us, over that decade, increased workloads, increased patient acuity meaning our patients are sicker when they arrive at the hospital, stress, fatigue, and lack of job satisfaction.
"This is contributing to high staff turnover and low staff morale."
Payne said nurses felt their skills and knowledge was undervalued.
"I would say that [strike action] is likely, in as much as, we've been talking about it.
"We're hopeful though that both Government and employers will step into this dispute to help members with their concerns about pay."
Payne said that if strikes happened, that would likely be 24 hours of all nurses walking off the job.
Registered nurse Freya Head said they didn't like to strike and leave their patients without care, but the current situation had gone on too long.
She said she had "often" thought of leaving the career.
"When I come home, every day, crying. Or I can't give care to a patient that I think is necessary care.
"You kind of look at yourself and go, okay, is this worth it?
"Is this worth my mental health? I'm giving 100 percent to my patients, I come home and have nothing to give to my family."
Registered nurse and union delegate Karen Durham said they didn't want to strike if they could help it, but they had to take a stand.
"We are running on an empty tank at the moment.
"We're stressed at work, there's overtime, and people are becoming tired and frustrated."
DHB spokesman Dr Ashley Bloomfield said they'd worked hard on an offer for nurses.
They would now have an urgent meeting with NZNO on Tuesday, in the hopes of avoiding strikes.
"Before we can come back with another offer ... we need to understand what it is nurses are looking for in terms of pay and conditions, and their concerns around workload and work conditions."
He thought there was "a very good chance" that the two groups could make progress, "as long as we keep talking".
"Interestingly the NZNO in their release said clearly that their preference is to have the deal settled and only take industrial action as a last resort, and we absolutely agree."
But he couldn't say what DHBs could offer financially beyond their current offer.
"All I can say is we are working very closely with the Ministry of Health and the Minister, because any options we put on the table, obviously any increased pay offer will have financial implications and we have to find the money somewhere.
"It's also what else DHBs can do to reassure nurses that the pressure they're under is going to be addressed and their concerns acted on."
"Nurses are highly respected and essential members of the health team and we don't want them thinking they have to take industrial action to be heard. Obviously we're disappointed that our latest offer has been rejected but DHBs will ask for an urgent meeting with the NZNO to find a way forward."
The decision comes after voting closed on Friday, on whether nurses would accept a revised collective agreement between nurses and DHBS.
The deal was for 27,000 nurses, hospital aides, and core midwives to get a 2 per cent pay rise as well as a $1050 lump sum.
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Ahead of the decision today, hundreds of nurses had been vocal about the offer, taking to social media to say the offer didn't go far enough. Strike action was openly discussed, due to unhappiness with working conditions, short-staffing and poor pay.
The NZNO had kept a low profile during voting, but today has announced it is launching a campaign for a better deal, #healthneedsnurses, along with a campaign website.
"We know that you, the members, want to be recognised for your qualifications, skills and for going the extra mile for your patients. Together we can make this happen," the NZNO said in the announcement.
DHBs across the country have put in place contingency plans to prepare for the possibility of strike action.
In the 1990s and early 2000s strike action was taken at individual DHBs, including Canterbury and Waikato, as nurses from those areas called for better regional collective agreements.
Some strikes saw all elective surgeries and outpatient clinics cancelled, and non-member nurses coming in to cover for unionised colleagues.
The Council of Trade Unions has backed the union members' vote to reject the offer.
President Richard Wagstaff said it was in everyone's interests, including the District Health Boards (DHBs) that these negotiations concluded with a fair outcome as swiftly as possible, and he would do whatever he could to help facilitate that.
"We all know that our health services and the people that run them have been stretched to breaking point after nine long years of chronic under-funding," he said.
"The return of this vote shows the level of unmet need that's out there for the nurses, midwives and care assistants who have been covering the gap."