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By Nick Triggle
Health correspondent
The 300,000 nurses who are Royal College of Nursing members are starting to vote on strike action over pay.
The ballot is opening with with the RCN recommending its members walk out - but the government urged nurses to consider the impact on patients.
It is the first time in the union's 106-year history it has balloted all its UK members.
The RCN wants a rise of 5% above the RPI inflation rate of 12% - but no UK nation has offered close to that.
- In England and Wales, NHS staff, including nurses, are being given an average of 4.75% more, with extra for the lowest paid
- In Scotland, 5% has been given
- In Northern Ireland, nurses are yet to receive a pay award
A spokeswoman for the Department of Health and Social Care in England pointed out the independent NHS Pay Review Body had recommended its pay award.
And it followed a 3% pay rise last year, in recognition of work during the pandemic, despite a public-sector pay freeze.
"We value the hard work of NHS nurses and are working hard to support them. Industrial action is a matter for unions and we urge them to carefully consider the potential impacts on patients," she added.
Scottish Health Secretary Humza Yousaf said: "Any ballot for industrial action is disappointing. We are engaged with health unions and I hope we can come to an agreement on pay in the near future."
But the RCN said it had commissioned research showing average pay had fallen by 6% between 2011 and 2021, once inflation had been taken into account, compared with the 4.6% average for the whole economy.
Starting salaries for nurses in England are currently just above £27,000, rising to nearly £55,000 for the most senior nurses.
The RCN said the average pay for a full-time established nurse was just above £32,000 last year - similar to average pay across the economy.
The union is inviting members of the public to co-sign a letter to the prime minister, backing the RCN's stance.
General secretary Pat Cullen said: "This is a once-in-a-generation chance to improve pay and combat the staff shortages that put patients at risk.
"Governments have repeatedly neglected the NHS and the value of nursing. We can change this if together we say enough is enough."
The 380,000 members of Unison, including about 50,000 nurses, are also being balloted.
These ballot papers have been sent out in Scotland, with the rest of the UK following suit in the coming weeks.
Midwives in Scotland have also been balloted on strike action, by the Royal College of Midwives, while the British Medical Association has said it will ballot junior doctors over industrial action.
The RCN ballot closes early next month.
In 2019, RCN members went on strike in Northern Ireland over pay, while nurses who are members of Unison walked out in 2014 over pay.
During strike action, some nurses will continue to work to ensure emergency and urgent services continue.