Hundreds of surgeries were postponed on Wednesday as many of NSW's 50,000 nurses and midwives took to the streets to agitate for an immediate 15 per cent rise.
The government has declined to go above 10.5 per cent over three years without changes to a plan to increase nurse-to-patient ratios.
The major rift with the state's largest union comes after teachers, paramedics and police were granted large salary rises following a decade of capped increases.
Fuelling the nurses' fury is their Victorian and Queensland counterparts being promised substantial increases in pay to overcome gender disparity in the public sector.
More than 12,000 nurses and midwives rallied outside NSW parliament on Wednesday, with several signs attacking Premier Chris Minns as a liar.
Another suggested he had a small bowel obstruction because he was "spewing crap".
"We are the largest union in NSW, we are proud and strong and we are going to stick it to you," Nurses and Midwives​ Association president O'Bray Smith warned decision-makers.
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The 24-hour strike, the third major stop-work action from the union under the Labor government, is estimated to force the postponement of 600 to 700 surgeries, according to NSW Health.
It went ahead despite a previous commitment from the union to pause industrial action while the state's wages umpire considered the pay dispute.
That commitment led to NSW Health paying an immediate three per cent wage rise.
The government "honoured our end of the bargain", Health Minister Ryan Park said.
"There was an expectation, though, that this industrial action was not going to take place," he said.
A strike by public sector nurses and midwives caused hundreds of elective surgeries to be cancelled. (Steven Saphore/AAP PHOTOS)
Mr Park acknowledged his nurses were among the lowest-paid in the nation but said they received their highest increase in a decade in 2023 and the government was delivering on the union's "big ask" to improve staffing ratios.
Slowing that billion-dollar rollout in return for a 15 per cent pay increase over multiple years had been rejected, he said.
Another offer would raise NSW nurses to third-best paid in the nation.
A $697 million pay rise for police will be offset by changes to their death and disability insurance, while teachers agreed to a salary restructure to fund increased wages.
But the nurses union says the government should be finding extra money to fund pay increases.
The coalition has seized on the issue, saying it highlighted the premier had promised "the world and ... delivered nothing".
Nurses and midwives are demanding action, arguing they are among the lowest paid in the nation. (Steven Saphore/AAP PHOTOS)
Improved nursing ratios had only been improved in one hospital's emergency department, Opposition Leader Mark Speakman said.
"(The premier) has betrayed the nurses - delivering on neither increased wages, nor staff ratios," he said.
Attacked in question time on promises to nurses, Mr Minns highlighted the coalition wanted to reinstate its wages cap.
"During the midst of COVID, it wasn't a 2.5 per cent wages cap - it went to zero, a catastrophic mistake by the previous government," he said.
The union and the government are due back before the Industrial Relations Commission in a fortnight.
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