The Royal College of Nursing has voted "with great reluctance" to accept the government's revised pay offer for nurses in England.
Unions were angered by the staging of the pay rise
Its acceptance comes days after Unison, representing 450,000 NHS staff including some nurses, and the GMB union, with 9,000 members, accepted it.
Unions were angered by the government's staging of a recommended 2.5% rise in England, reducing the value to 1.9%.
Ministers improved the deal, but the RCN described it as "imperfect".
The improved offer included a £400 flat-rate rise for tens of thousands of the lowest paid NHS workers, as well as money towards registration fees.
The new deal is worth 3.4% for the lowest paid, but 2.08% overall.
The general secretary of the RCN, Peter Carter, said: "Today the RCN's ruling council has voted with great reluctance to accept the government's revised pay offer for nurses in England.
"Although the immediate threat of industrial action has now been lifted, the government should realise that nurses in England have accepted this offer with a very heavy heart."
He said the RCN did not believe the government's economic argument for giving nurses in England their pay award in instalments.
Prime Minister Gordon Brown has said that to maintain the government's economic strategy of low inflation and steady growth, public sector pay must be staged.
Health Secretary Alan Johnson said he was pleased the RCN had accepted the offer.