Nurses have issued their first strike notice after not agreeing with the outcome of salary negotiations.

Additional funding would be required for nurses to accept a revised collective agreement and avoid strike action, the nurses' union says.

The New Zealand Nurses Organisation (NZNO) issued district health boards (DHBs) on Wednesday with a strike notice for July 5, with another notice for July 12 likely to be issued next week.

ROSS GIBLIN/STUFF The New Zealand Nurses Organisation announces its members have rejected a revised DHBs offer, opening the door to strike action.

A DHBs spokeswoman said health boards would be implementing "contingency plans to ensure the safety of patients and staff" and emergency medical services would still be available during the strike.

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It comes after the NZNO announced on Monday its members had "strongly rejected" the DHBs' latest pay offer. Both parties have said they want to avoid strike action, and mediation is set for Friday.

ROBERT KITCHIN/STUFF DHB spokeswoman Helen Mason says people needing urgent medical attention should still go to hospital when nurses strike in July.

However, whether it can be avoided remains to be seen.

Health Minister David Clark said on Monday the DHBs' rejected offer, worth more than $500 million, was "ourbest offer". "People have to know that that's the money that's available and that's the situation we're in."

NZNO industrial services manager Cee Payne said additional funding was required to settle the dispute and avoid strike action, and the parties needed to approach mediation without predetermined positions.

ROSS GIBLIN/STUFF NZNO industrial services manager Cee Payne announces the latest pay offer to nurses.

"In response to the Minister, there will be a requirement for additional funding, but we need to be able to explore what that means and what will be required."

The NZNO sent out a survey to members on Monday asking what they wanted to see in any revised offer. The response period closed at 1pm Thursday, but Payne said the union had already received close to 13,000 responses.

"It's clear that nurses want to be valued, and they want their hospitals and their communities to be safely staffed."

ROBERT KITCHIN/STUFF DHBs spokeswoman Helen Mason holds a press conference in response to the nurses' union rejecting the DHBs' offer.

The NZNO's negotiating team would make a decision on whether any revised offer was good enough to present to members following mediation with the DHBs.

Payne said it would be preferable for any acceptable offer to be received by Monday afternoon so the union could give members a week to vote via an online poll.

And if mediation failed: "it'll be industrial action on the 5th of July."

DHBs spokeswoman Helen Mason said the health boards would implement "contingency plans to ensure the safety of patients and staff".

The strike should not deter or delay people needing medical attention from going to hospital that day, she said.

The call to strike came after NZNO members voted to reject the DHB's revised pay increase offer of 9 per cent for all member nurses by August 2019.

The Multi Employer Collective Agreement (MECA) offer included a $2000 lump sum payment to DHB nurses covered by the NZNO, and doubling their on-call hourly allowance from $4 to $8, and $6 to $10 on public holidays.

The $500 million package was the biggest pay offer nurses had seen in more than a decade. It offered a $38 million investment to hire another 600 nurses and midwives, increasing staffing levels 2 per cent.

It included the three 3 per cent pay increases, and the creation of two new pay steps for nurses.

The latest deal was more than what was recommended by an independent panel set up to try and navigate through an apparent impasse between the unions and district health boards (DHBs).

But Payne announced nurses had overwhelmingly rejected the pay offer, saying "the past decade of underfunding of DHBs has taken a heavy toll on nurses and their ability to provide safe patient care".

'NO MONEY LEFT'

On Monday, DHBs spokeswoman Helen Mason said there would be further mediation with NZNO, but made clear that no more money would be put on the table.

"The DHBs are going to be working very hard to do everything we can to reach settlement. Whilst we are hoping for the best, we need to plan for the worst," she said.

"I think a lot of our conversations are going to be about ensuring nurses are feeling really confident that DHBs are putting something additional on the table that wasn't there before. That's about the safe staffing programme, it's also about pay equity."

Mason said the DHBs primary concern was to ensure "safe services" if it came down to industrial action for the first time in 30 years.

Concerns were being taken seriously and steps were being made to address them, she said, before saying the current offer was the only one on the table.

"It's a very good offer, it's actually an excellent offer. We've essentially doubled the offer."

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