Standards and regulation

Ballot on industrial action in Northern Ireland

Find out more about the background, our FAQs and next steps

The Royal College of Nursing has taken the unprecedented step of balloting RCN members working in the Health and Social Care service (HSC) in Northern Ireland on industrial action - including strike action.

The nurse staffing crisis in Northern Ireland has developed over several years and the RCN has always made it clear that this crisis was entirely predictable. 

There has been an absence of effective workforce planning for nursing in Northern Ireland, as well as the imposition of cost-saving measures that have cut the number of nursing posts and reduced the number of nursing students in Northern Ireland. Other actions taken by HSC employers, such as recruitment freezes, have led to an over-reliance upon bank and agency staff. Recent increases in the number of nursing students are not sufficient to close the significant gaps in nurse staffing levels. Nurses have been viewed by the Department of Health and HSC employers as a cost that needs to be contained, rather than as a valued resource.

Vacancy rates

Vacancy rates within HSC trusts in Northern Ireland, according to the Department of Health (September 2019), are now over 2,790, or around 13% of the workforce. This includes both registered nursing and nursing assistant posts. The RCN has constantly raised concerns at all levels within the health and social care system about inadequate workforce planning and its impact upon recruitment and retention. Nurses have reported concerns that there are not enough staff to provide safe and effective care for patients. The Department of Health Delivering Care policy framework for nurse staffing has identified the number of nurses required to deliver safe care in a number of clinical areas but has not fully funded each phase. Nurses are being left to manage high levels of risk on a daily basis without adequate support. These experiences are having a direct impact upon the health and well-being of nurses, and sickness levels amongst nursing staff are consequently increasing.

Pay inequality

Nurses in Northern Ireland are the lowest paid in the UK. For example, a registered nurse at the top of band 5 in Northern Ireland earns £797 a year less, and a nursing assistant at the top of band 2 £711 a year less, than their equivalents in England and Wales. A registered nurse at the top of band 5 in Northern Ireland earns £1,427 a year less, and a nursing assistant at the top of band 2 earns £1,706 a year less than their equivalents in Scotland.

Negotiations with the employers

Pay awards for HSC staff on Agenda for Change terms and conditions have been agreed for the rest of the UK for 2019-2020 and 2020 -2021. Pay discussions between the HSC trusts, the Department of Health and the health trade unions in Northern Ireland have been underway for a number of months without significant progress having been made.

Unacceptable lack of progress

The RCN believes that the lack of progress in these discussions is unacceptable and constitutes a failure by HSC trusts and the Department of Health to address the pay inequality that exists between nurses in Northern Ireland and those in the other three UK countries. Furthermore, the issue of pay is a central factor in the recruitment and retention of nurses and has therefore directly helped to create the current nurse staffing crisis in Northern Ireland. This must be addressed.

Ballot for industrial action

As a result, and for the first time in its history, the RCN (UK) Council has authorised the RCN in Northern Ireland to ballot members employed within the HSC in Northern Ireland for industrial action up to and including strike action.

If a majority of those casting their vote in the ballot demonstrate support for industrial action, then the nature of that industrial action will be agreed with members and communicated to members and employers in advance of any action being taken. Members are asked to answer two questions on the voting paper, so the outcome may be that members will show support for industrial action short of a strike, or for strike action, or for both forms of industrial action.

Any action would commence within four weeks of the closing date of the ballot as authorised by RCN Council.

Examples of industrial action, short of strike, may include

  • refusing to carry out any non-nursing duties, such as accompanying patients who do not require a nurse during transfer, transporting pharmacy.
  • refusing to undertake administration tasks not associated with patient care or the recording of patient care, such as carrying out audits or preparing management reports not related to patient care.
  • refusing to input data to information systems, excluding that which is part of the patient record.
  • ‘working to rule’, which is a form of action by which employees do no more than the minimum required by the terms of their contract of employment; this could involve, for example, refusing to do unpaid excess hours, and insisting on taking scheduled breaks and not working bank shifts on designated days of industrial action.

Strike action means not undertaking any work at all on the day (or part of the day) specified by the RCN. Any strike action called by the RCN will ensure that patients are not put at any additional risk by industrial action, and members will never be asked to act outside the requirements of the NMC Code. The RCN will always ensure the maintenance of life-preserving services in acute and emergency situations, and we will ensure that robust contingency arrangements are in place in the event of a major incident.

No individual registered nurse, midwife or nursing assistant will be asked to make their own decision about what they do or don’t do in a strike action. They will be directed at all times by the local strike committee who will consult with clinical experts about how to maintain patient safety.

RCN Council was clear in its decision to authorise the ballot that members should never be asked to act in any way that is detrimental to the well-being of patients. 

The ballot closed on Wednesday 6 November 2019.

Industrial action - legislation and RCN Code of practice

Industrial action is regulated by trade union law and the RCN’s own rules reflect the legal processes which must be followed.

In addition, the RCN has its own specific rules on industrial action which it must also follow. These are set out in the RCN Standing Orders (Standing Order 3) and the RCN’s Code of Practice on Industrial Action.

In line with the legislation the RCN must appoint a scrutineer, from a prescribed list, to oversee an industrial action ballot.

For the purposes of this ballot the RCN has appointed Electoral Reform Services Ltd (ERS).

ERS will manage and dispatch the ballot papers (by post) to members in Northern Ireland eligible to take part.

Any member who has not received a ballot paper or who has mislaid theirs and wishes to obtain a replacement should email us at

Page last updated - 11/09/2020