The Irish Nurses and Midwives Organisation (INMO) has rejected pay proposals aimed at addressing staff shortages in the health sector by a margin of 94%.
The INMO executive will meet on 5 November to decide its next move, which could include a decision to ballot for industrial action.
The INMO has insisted that a 12% across the board pay rise - to bring nurses into line with other health professionals like physiotherapists - is essential to address recruitment and retention difficulties in the health sector.
However, the Public Service Pay Commission rejected their demand for an across the board increase.
Instead it recommended a package of targeted allowances worth €20m a year, but which would only benefit about half of union members.
Minister for Health Simon Harris has noted the result of the ballot taken by INMO members.
In terms of the pay proposals which have been put forward, it is estimated that approximately 18,000 nurses and midwives would benefit from the recommendations made by the Public Service Pay Commission.
In addition, the Government has made proposals to address the issue of new entrant pay which will benefit approximately 10,000 nurses to the value of around €3,000 each.
The minister said these measures will improve the overall pay package for the majority of nurses and midwives and they show that the Public Service Stability Agreement and the related negotiation process are delivering significant improvements for nurses.
Mr Harris said he expects further engagement with the INMO to take place over the coming weeks.
PNA members also reject the latest pay proposals
Meanwhile, nursing members of the Psychiatric Nurses Association (PNA) have also voted to reject the proposals put forward by the Public Service Pay Commission.
The PNA will now convene a special National Executive Committee meeting in November with a view to seeking a mandate for industrial action, up to and including strike.
The association’s General Secretary, Peter Hughes said: "For the Pay Commission to conclude that there is no generalised problem in recruiting and retaining nurses at a time when the PNA has identified 700 nursing vacancies in mental health services across the country has clearly angered nurses and that anger is reflected in today's ballot result."
542 patients waiting for hospital bed - INMO
There are 542 patients waiting for admission to a hospital bed today, according to the INMO TrolleyWatch system.
Of these, 382 are waiting in the emergency department, while 160 are in wards elsewhere in hospitals.
The worst-affected hospitals today are University Hospital Limerick with 52 patients waiting; University Hospital Galway with 47 patients and Cork University Hospital also with 47 patients waiting.
Additional reporting Fergal Bowers