This has been a momentous week for nursing in Northern Ireland. For the first time, members of the Royal College of Nursing here have voted to take industrial action, including strike action.
Nurses did not take this decision lightly. For many years, nurses have been highlighting the unacceptable staffing pressures within our health service.
We now have around 3,000 unfilled nursing posts in the service, with a similar number estimated in our nursing homes.
It is important to be clear about what this means. An unfilled nursing post is not a statistical footnote.
It represents a nurse who should be working in our hospitals, in our health centres, out in our communities, providing care. But around one in every eight of our nurses is missing.
This means that the people of Northern Ireland are not receiving the level of health care to which they are entitled.
It is part of the reason why, for example, the number of patients waiting longer than 12 hours for emergency department treatment in Northern Ireland increased from 1,711 to 3,465 over the last year.
The Department of Health target is that no patient should wait longer than 12 hours.
It is part of the reason why the number of patients waiting longer than a year for surgery increased from 18,080 to 23,996 during the same period. The Department of Health target is that no patient should wait longer than a year.
There is a direct link between these workforce gaps and pay. Nurses' pay in Northern Ireland has fallen significantly behind the rest of the UK.
Not only is this completely unfair but it sends a message to nurses that they are not valued or respected.
It makes it difficult to recruit and retain the nurses we desperately need to provide healthcare to the people of Northern Ireland.
Why should a newly-qualified nurse in Northern Ireland stay here when they know they can earn up to £2,000 per year more in Scotland?
If a nurse from overseas wants to come and work in the UK, what incentive is there to choose Northern Ireland when they can earn thousands of pounds more each year elsewhere?
Patients hugely value the care nurses provide - we already know that - but it's clear that health service leaders in Northern Ireland don't.
This week we have heard the same line from the Department of Health that it has been using for many years now.
It repeats the refrain that there is simply no money to pay nurses fairly, other than by cutting services. This is a disgraceful statement and little more than blackmail. It has angered nurses here beyond belief.
Just to be clear, the current annual health budget for Northern Ireland is around £5.7bn. The £103m that the department claims is needed to pay our nurses the same as in England and Wales represents around 0.018% of this total.
Yet rather than find the money, the department continues to squander millions each year on expensive agency fees to plug the workforce gaps, or on a 'transformation' process that has been going on for seven years without achieving its objective of making health and social care services more responsive and accessible to the people of Northern Ireland.
This week nurses have spoken clearly and collectively on behalf of patients and the people of Northern Ireland.
It now up to those who lead our health and social care service to respond appropriately and quickly.
Pat Cullen is the director of the Royal College of Nursing NI