Nurses are to be balloted over whether they want a national vote on whether to take industrial action over pay.
Nurses are unhappy about pay rise offers
Nurses in England, Wales and Northern Ireland have been offered a 1.5% pay rise followed by an extra 1% later.
The government says this is fair and affordable but nurses want the 2.5% immediately - as happened in Scotland.
The Royal College of Nursing ballot will ask NHS members whether they want to be balloted on what would be the first ever national industrial action.
The RCN met on Wednesday to discuss their options after an emergency motion passed unanimously at the RCN conference in April called on the government to implement a full 2.5% pay rise as recommended by the independent pay review body.
RCN General Secretary Peter Carter said: "Today's decision by council was not arrived at lightly, but there are only so many times nurses can be asked to accept the unacceptable.
"Nurses are dedicated public servants who work hard and play by the rules.
"So, when we end up in a situation where nurses are forced to talk about industrial action, then we know that they have been pushed to the limit.
"This is a ludicrous position to find ourselves in and I urge the government to meet with us immediately to resolve this situation."
The RCN said the pay award was the equivalent of a below inflation 1.9% pay rise and was saving the government £60m.
Historically nurses have not been allowed to take industrial action but a rule change in the mid-1990s permitted measures which do not harm patient care.
This means an all-out strike would be highly unlikely but it does allow nurses to take other steps such as refusing to do overtime.
Another option would be to refuse to fill in paperwork which enables NHS trusts to show they have met their targets.
The government has said the pay offer was a sensible increase that was fair for NHS staff and affordable for the economy.
A Department of Health spokesman said: "We understand the frustrations the RCN is expressing on behalf of members about the pay offer but staging was essential to align with the Government's inflation target."
Average pay has increased from £12,000 for a basic grade nurse in 1997 to £20,000 today. Avearge pay has also increased by a similar amount to £25,000.
Lid Dem health spokesman Norman Lamb said: "Nurses are the backbone of the health service - they should not be paying the price for Labour?s incompetent handling of the NHS."
And shadow health secretary Andrew Lansley added: "If Gordon Brown sees the NHS as an immediate priority, then he must respond to nurses and their concerns."