Nursing leaders have lodged a formal trade dispute with the Scottish Government for the first time as a row over pay escalates.
Bosses at the Royal College of Nursing in Scotland said they had "no choice" but to notify ministers of the dispute, amid "serious concerns" over the impact of wages on recruitment and retention in the profession - claiming "worrying numbers" of nurses are now considering quitting.
Julie Lamberth, the chair of the RCN Scotland board, has written to Health Secretary Humza Yousaf.
It comes after the Scottish Government confirmed last month that the pay deal, which offers NHS workers an average increase of 4 per cent, was being implemented immediately after most unions voted to accept it.
The wage rise - said by ministers to be the biggest pay uplift since devolution - applies to staff in the NHS apart from doctors, whose pay is negotiated separately.
But the RCN has been campaigning for a 12.5% hike in wages, claiming nursing pay has failed to keep pace with the rising cost of living in recent years.
In her letter to the Health Secretary, Ms Lamberth said: "You have left us with no choice but to notify you of this dispute.
"The Scottish Government has relied on the good will of nursing staff for too long.
"For years, we have been responding to the challenge of delivering safe and effective patient care, in the face of increasing demands, staff shortages and low pay. These issues have been exacerbated by the pandemic.
"Nursing staff are exhausted, with worrying numbers considering leaving the profession.
"Every patient needs and deserves the best quality of care, this can only be safely achieved with the right number of nursing staff with the right skills and expertise.
"Today's action, writing to the Cabinet Secretary to lodge our trade dispute, is a formal expression of our members' frustration and concern for patient safety.
"We are sending a clear message that the time to value nursing as a safety-critical profession is now."
Labour said the Scottish Government "must take notice of this unprecedented step and resolve this dispute by giving nurses a fair pay deal".
Health spokeswoman Jackie Baillie said: "Nicola Sturgeon has been more than happy to stand on her doorstep and clap for our nurses, but they don't need a PR stunt, what they really need is a decent pay rise.
"This should have been an opportunity to give nurses the recognition they deserve after decades of under-appreciation.
"Instead their voices have been ignored to the extent that RCN Scotland has had to enter into a trade dispute for the first time in their history."
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