DHBs are vowing to avert strike action, saying they'll do everything they can to settle the employment agreement.
DHB spokesperson Helen Mason said they would go into the urgent mediation nurses wanted.
"Nurses, midwives and health care assistants are a highly respected and valued part of the modern team-based approach to health services, and we are extremely concerned about the threat of industrial action.
"The current offer on the table is an excellent offer, and it's about much more than base pay rates. DHBs are committed to safer staffing, which includes a commitment to an additional 500 nurses to alleviate staffing concerns.
"DHBs have committed to working with NZNO on pay equity and nurses concerns about pay equity."
Mason said the offer would invest an extra half billion dollars in staff and improved working conditions.
She said they had doubled the pay rates from their original offer, so there would be no more money on the table.
"Some of the things that will be important to nurses will be that DHBs meet their commitments on safe staffing and more nurses.
"If we do face strike action on the 5th and 12th of July, DHBs will be deferring all non-urgent services, to reduce demand on the system.
"If the strike goes ahead it will be a really significant national event, there hasn't been a nurses strike in 30 years, and we take that really seriously."
Industrial services manager Cee Payne said nursing and midwifery was an essential service, so negotiations needed to be held urgently to avoid strike action.
"Alongside the setting up of urgent mediation or facilitation, NZNO is surveying members to seek clarity about the specific issues that members require to be addressed.
"Nurses and midwives do not trust that their work environment or patient care will improve in the short term.
"While the revised offer included new funding to address short staffing, concern remains that this may not be enough to make a real difference.
"While the revised offer was substantially improved, compared to the previous one on pay for some members, members have rejected this. There may be concern about the variability of the offered pay increases."
Payne said that the pay equity offer didn't specify how and when the changes would be brought in, which created uncertainty for members."
Payne said many of their members had voted in favour of strike action.
While she wouldn't give out percentages of the vote result, she said there was an exceptionally high turnout.
"We're going to do everything we can to see if we can get an improved offer out of mediation. We have the ability to conduct an online ballot before the 5th of July," Payne said.
"A very significant number have voted to take strike action.
"I'm sure there are a range of opinions just as there are across any organisation of this size in the public sector. But many are committed to strike action."
Payne said that while the latest offer would see top level nurses get a 15.9 per cent raise over three years, all other nurses would only get a 3 per cent raise per year over three years.
She said that if strike action went ahead, NZNO was committed to providing life-preserving services during the action.
Health Minister David Clark said he was disappointed at the nurses' decision, and there was no more money in the kitty.
"It is the best offer we've been able to support, we've been clear about that.
"I can assure people that life-preserving services planning is well advanced. So we're preparing for the worst, but having said that, both sides have given strong signals that they're prepared to work with mediation and facilitation, and we're encouraged by that".
Clark said the pay offer was the most generous in a decade.
"Nurses are a vital part of our health workforce and clearly feel they have been undervalued over the last nine years. Their frustration is understandable," he said.
"I think everyone agrees nurses should be paid more than they are now, but it takes more than one pay round to address nine years of neglect.
"We have a fiscal limit, and we've put out there the best offer we could put out there."
Clark said he hoped "cool heads will prevail" and industrial action could be avoided.
"The deal that's been rejected today is the largest nurses and midwives have been offered since their historic pay jolt 14 years ago under the last Labour-led Government.
"The proposal added an extra two steps for the longest-serving and most experienced nurses and would see most full-time registered nurses earning an extra $10,000 a year within 18 months. That is a far better deal than that offered under National."
Green Party co-leader Marama Davidson said nurses deserved to be pay more and supported NZNO's call for urgent mediation.
"Nurses are totally professional, so for them to reject an offer of 9 per cent over 15 months reveals how undervalued they feel after nine years' squeezing by National," Davidson said.
She said everyday it was becoming clearer the previous government patched its finances together by not just neglecting hospital buildings like Middlemore Hospital, but by underpaying staff who run them and tend to New Zealanders when they need it most.
"Nurses need a significant pay catch-up, but this Government is going to find it challenging to recover nine years of neglect in a single year.
"The nursing profession has been dominated by women and, like many women-dominated professions such as teachers, has been undervalued and underpaid in comparison to male-dominated professions.
"The DHBs have said the latest dispute is not about pay equity but we look forward to that being addressed as soon as practicable," Davidson said.
Association of Salaried Medical Specialists executive director Ian Powell said it was time for health bosses to put aside their point-scoring and step up to avoid national strikes.
"Senior doctors are sad that their hospital nursing colleagues have been put in a position where strike action, which is always a last resort, is considered necessary," Powell said.
He said nurses were a skilled and dedicated workforce and the fact things have deteriorated to this point reflects a crisis of leadership in the public health system.
"This has intensified under the last eight years of deliberate Government under-funding which has taken its toll.
"It has resulted in the devaluing of the vital role of nursing both by Government and district health boards.
"Nurses are a vital part of the public health system, working alongside other health professionals such as senior doctors to provide quality patient care. They don't deserve to be treated as a balance sheet liability," Powell said.
New Zealand Medical Association chair Kate Baddock said this issue was one that would have flow on affects across the health system.
"We are at a difficult junction."
Baddock said there was a need to invest into the workforce but equally that investment created problems with sustainability and capability.
"It was an extremely good offer but whether it was sustainable ..that's tricky."
Baddock said the implications if nurses did go ahead with the strike would be overwhelming problem for doctors.
Musa said strike action was a last resort, but if it went ahead patient safety would be the first priority.
What was on offer:
• All members to get a base level pay rise of 9 per cent (three 3 per cent rises) by August 2019.
• DHB registered nurses and midwives with more than five years' experience to get an additional 6 per cent pay rise by December next year.
• Senior members to get a 10 per cent pay increase (two 3 per cent, one 4 per cent rise) by August 2019.
• All part-time and casual members to get an additional lump sum payment of $2000 by next month.
• On-call allowance will increase from $4.04 to $8 per hour, $6 to $10 on public holidays, by June 2018.
• DHBs to receive a $38 million investment which will allow an extra 500 graduate nurses to be employed effective immediately
