The largest nursing union in Northern Ireland has vowed it will push to ballot its members on industrial action following the failure of the Department of Health to award thousands of workers a pay rise.
The Royal College of Nurses (RCN) has said it committed to the ballot after feeling its concerns have been ignored by the Health Minister.
With more than 14,000 members, the union said the move followed the failure of DUP Health Minister Simon Hamilton to grant a recommended 1% pay award for 2015/16.
Northern Ireland is the only part of the UK in which an NHS pay deal has not been secured. The RCN claims an experienced staff nurse here is paid £279 a year less than in England, and £561 less than in Scotland.
In November, its Northern Ireland board voted to ask the union's governing body in London for authorisation to ballot on industrial action. Yesterday, it said the board was considering industrial action that excludes strikes. This includes withdrawing overtime and imposing work-to-rule, which could impact on an already overstretched service.
Janice Smyth, director of the RCN in Northern Ireland, said the failure to give a pay award to nurses in Northern Ireland was a "failure in equality".
"Not only are our members paid less than their counterparts in England, Scotland and Wales, but many other public servants here have received a pay award, leaving nursing, a predominantly female profession, subjected to unfair treatment," she added.
"The message that the care they provide to the people of Northern Ireland is not valued is being made loud and clear.
"Nurses and healthcare assistants are committed and dedicated to the care of patients. This is borne out in practice when, as a result of trying to provide nursing care in a system that is not fit for purpose, they often take on additional roles to ensure the effective delivery of services. This has resulted in enormous pressure on the nursing workforce.
"The decision to ballot our members was not taken lightly. When we end up in a situation where there appears to be no alternative to industrial action, then we know that nursing staff have been pushed to the limit.
"The RCN has made efforts to engage in discussions about pay but, unfortunately, it would appear that nurses' pay is not considered a priority for the DHSSPS."
A DHSSPS spokesman said: "The minister values the essential role that nurses play in the continued provision of a high standard of care in Northern Ireland. His priority is the delivery of high quality, safe and effective services for patients and clients.
"The minister is aware of the RCN council decision to ballot their members in NI for industrial action and has indicated his disappointment that this is the case.
"His department is keen to progress discussions with trade unions. Officials have repeatedly sought to engage with trade unions, who have refused to enter into discussions on a settlement for 2015/16. The department remains hopeful this will change and that unions will engage."