LEADERS of the largest nurses' union, the non-TUC Royal College of

Nursing, yesterday voted overwhelmingly to jettison its no-strike rule

in a reversal of a 79-year policy of moderation.

Their angry reaction to the Government's ''miserly'' pay offer of 1%

nationally, with the prospect of an additional 2% by way of local

bargaining, resulted in a 488 to 3 vote, with two absentions, at the

RCN's annual congress in Harrogate.

The RCN's 300,000 members will now be balloted on the new rule, which

allows for limited action.

The ballot will take place next month and a two-thirds majority is

needed for the rule change to be endorsed, and even then there would

need to be a further legal industrial action ballot before action could

be taken.

Yesterday's dramatic decision opens the way to possible joint action

with the TUC health unions, who are already preparing the ground for

industrial action ballots among their 600,000 members, in protest at

broadly similar pay offers.

Mr Bob Abberley, head of health for Unison, which has some 440,000

members employed in the NHS, welcomed the RCN decision.

''If RCN members back this decision in their ballot, the Government

will never again be able to drive a wedge between the RCN and the other

half of the nursing workforce in Unison,'' he said.

It would mean that college members would be able to stand shoulder to

shoulder with Unison's nurses and other health staff this year, in an

effective nationwide campaign to secure a fair pay deal for all staff.

However, patients could rest assured that all the unions were pledged

to take action that would not put them at risk, Mr Abberley added.

In an opening speech to RCN delegates, Miss Judith Hunter, chair of

the RCN governing council, called for support for the change -- and won

a standing ovation.

Miss Hunter said that, while the fundamental principle of not harming

patients remained the same, conditions in the NHS had changed. The RCN

would still never take industrial action which would harm patients.

However, she went on: ''What has changed is the environment in which

we nurses are working in. It has changed beyond recognition. Now nurses

are in an environment that talks numbers, data, winners and losers,

statistics, and market forces. These have become the fundamental aspects

of caring.''

Miss Christine Hancock, the RCN general secretary, said directly after

the vote it had showed clearly that the Government had pushed nurses too

far -- the move was not just over pay but over changing working

conditions in the health service.

Asked about the likelihood of industrial action, she said: ''This is

no poker game. There is real concern and real anger.''

Nurses were concerned not for themselves personally, but for the

''reality of what is happening in the health service at the moment''.

However, Health Minister Gerald Malone warned that any sort of action

by nurses ''would mean patients feel the pain''. In a statement, he said

he regretted the RCN decision, adding that he felt potential action was

still a long way off.

''The RCN appears to be labouring under the illusion that limited

industrial action would not impact on patients. Any sort of action would

mean patients feel the pain. Simply put, if nurses do not fill in forms,

trusts will not be able to treat patients and waiting times will rise.

And what forms does the RCN have in mind?''

He claimed that 321 NHS trusts out of a total of 485 had made offers,

three quarters of them at 3% and said that he expected the remaining 164

to have come forward with offers by the end of the month.

Later, Miss Hancock told a news conference it was ''very difficult''

to tell whether nurses would take action in the current pay dispute.

Latest figures showed 115 trusts had made offers worth 3% with no

strings attached -- the condition of the RCN. She believed 300 offers

were needed for victory.

She emphasised repeatedly that nurses would not harm patients and that

industrial action remained for the RCN an action of last resort.