Founded in 1916, the Royal College of Nursing (RCN) can lay claim to be the world’s largest trade union centered on nurses. With 435,000 members in the United Kingdom — from registered nurses and midwives to health-care assistants and nursing students — today it’s wielding its strike prerogative for the first time in its 103-year history. It’s made this choice in far from ideal circumstances — and yet with the National Health Service (NHS) under pressure, the decision for defensive action comes not a moment too soon.

On November 7, after a ballot lasting four weeks, nurses in Northern Ireland voted in favor of industrial action set to commence on December 3. After four months of abortive negotiations with Northern Ireland’s devolved Department of Health, the consensus was nigh on unanimous. Some 96 percent of those who took part voted in favor of industrial action; 92 percent voted for a strike.

But why take action now, right on the cusp of a period when the health service faces its busiest time of the year? It’s a textbook case of critical mass in action. Indeed, for the Department of Health, the writing isn’t so much on the wall as it is scrawled across every bedless ward and overstretched waiting room throughout Northern Ireland.

With the health service operating under a 12 percent staff shortfall, the three thousand unfilled nursing posts have put an unworkable strain on health-care professionals across the board. This shortage has only aggravated preexisting issues like spiraling waiting lists (nearly 300,000 people — approximately one-sixth of the population — are on a waiting list for a first appointment with a consultant), emergency room waiting times (the number of people waiting more than twelve hours at emergency rooms has doubled since last year), and bed shortages (the average number of beds dropped by 250 over the last five years — 4.1 percent of the total). And that’s only grazing the surface.

The evincible right to pay parity has propelled many strikes since the dawn of modern nursing in the early 1900s — and we have already seen such strikes in Chicago and the Republic of Ireland in 2019. Beyond the more entrenched issues mentioned above, nurses in Northern Ireland also have a clear-cut case over pay: after all, they’re the lowest paid in the UK. While a registered nurse in Scotland at the bottom of band 5 earns £24,670 a year, and those in the same position in England and Wales take home £24,214, nurses in Northern Ireland earn £22,795. RCN has itself highlighted the negative repercussions of such inequality — it insists that pay “is a central factor in the recruitment and retention of nurses and has therefore directly helped to create the current nurse staffing crisis in Northern Ireland.”