Nurses have cranked up the pressure on embattled Health Secretary Andrew Lansley by moving nearer industrial action.
Delegates at the Royal College of Nursing conference voted 97% in favour of a motion saying members should be balloted on strike action if there was any challenge to their pay agreement.
RCN chief executive Dr Peter Carter said the vote was "a symptom of nurses feeling that the government may be listening but they are not hearing".
In another blow to Mr Lansley, nurses also voted massively in favour of a motion stating that his reforms of the NHS will not benefit patient care.
Nurses hit out at health minister Anne Milton earlier in the week when she said an offer was still on the table for no compulsory redundancies in return for nurses accepting a two-year pay freeze when they move up pay bands in accordance with their experience.
The proposal, made by NHS Employers last year, was rejected by all major health unions including Unison, the British Medical Association and the RCN.
The RCN described the proposal as an "attack on hard-working nurses" and said NHS Employers had been unable to even guarantee that more than 100 trusts would stick to any agreement on no compulsory redundancies.
However, Ms Milton told nurses the proposal was still there, adding: "These are difficult times and we are walking a financial tightrope."
She said opting in to the pay freeze would mean no compulsory redundancies for nurses in pay bands one to six and "as few as possible for other staff".
Copyright © Press Association 2011