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Extended emergency department wait times and delays to elective surgeries are expected in NSW today as nurses and midwives walk off the job to rally for a larger pay rise.
Thousands of nurses and midwives brandishing signs and chanting "we want 15 per cent" have marched from Sydney's Hyde Park to Parliament House.
Part of the city's CBD has been closed and mounted police are patrolling the streets.
It is the second industrial action taken by the Nurses and Midwives Association in less than three weeks.
The union this week rejected a recommendation from the state's Industrial Relations Commission (IRC) to accept a 3 per cent pay rise with backpay.
NSW pay lags behind other states
The union is pushing for a one-off 15 per cent pay rise, after rejecting an offer from the Minns government for a 10.5 per cent pay rise over three years.
The government previously said it cannot afford to meet the union's demands, arguing it could lead to other emergency workers demanding better pay conditions as well.
Nurses and midwives in NSW have taken industrial action for the second time in three weeks. (ABC News: Victoria Pengilley)
Union secretary Shaye Candish said wages should be brought in line with other states.
"Nurses and midwives are paid approximately 18 per cent less than nurses in Queensland, which makes it really difficult to keep nurses here in our state," she said.
The average salary for a registered nurse in Queensland ranges from between $79,058 to $106,144, according to ABS data.
The average salary in NSW for the same role from between $69,810 to $98,014.
Victoria has the highest paid nurses, with salaries capped at just shy of $130,000.
Nurses and midwives rally outside Parliament House (ABC News: Alex Lewis)
Mackenzie Porter took up a new graduate midwife role at Wollongong Hospital after completing her study in Queensland.
Tired after a 12-hour night shift, Ms Porter on Tuesday morning said the union's push for an immediate 15 per cent pay rise was too important not to participate.
"I earn $35 an hour with two degrees and my friends up in Queensland earn at least $45. It's very enticing to leave," she said.
NSW Health urge against action
Health Minister Ryan Park said he was disappointed nurses chose to take industrial action, rather than accept the government's interim wage offer.
In an email sent to members of staff, NSW Health said union members had "no right to strike" given the IRC issued orders to end strike action earlier this month.
"The orders issued by the IRC are binding," the email read.
"Strike action has an impact on our public health system."
Nurses and midwives march to Parliament House to protest the government's wages offer. (ABC News: Victoria Pengilley)
NSW Health asked managers to reiterate the IRC's orders to staff and "provide individuals with a copy of the orders."
The department said staff who do participate in today's industrial action are not to be offered 'make up time' or overtime to make up lost pay "unless clinically appropriate."
Tempers flare in parliament
The rally could be heard inside the lower house at Parliament House during question time and was weaponised by the Opposition.
"The premier can't hear over the voices of the nurses outside," shadow health minister Kellie Sloane said.
Mr Minns acknowledged there were "very angry nurses out there" but said the former government's wages cap was to blame for nurse pay in NSW falling behind other states.
"The truth of the matter is the government can't make up for a decade in lost wages in a single year," he said.
For the first time as premier, Mr Minns was called to order after seemingly ignoring Speaker Gregory Piper's attempts to pause proceedings.
After question time, Opposition Leader Mark Speakman said the premier's demeanour showed he had lost control of the situation.
"The premier today was rattled, he was petulant," Mr Speakman said.
Life-preserving staff remain in place
Mr Park urged anyone in life-threatening conditions to still call triple-0 or present to emergency, but said anyone with non-urgent conditions should stay away from emergency departments.
"If it's not a critically important issue that they need to get resolved or an accident they need emergency treatment on, they should be calling Healthdirect," he said.
"That will provide them with an alternative pathway to health care."
Health Minister Ryan Park asked people needing non-urgent treatment to avoid emergency departments. (ABC News: Anushri Sood)
Life-preserving staff will remain in place in public hospitals but widespread disruptions are expected.
"[Nurses] certainly don't take this action lightly, and they continue to be committed to making sure patients are able to access life preserving staffing," Ms Candish said.
Contingency plans are in place across public hospitals during the strike, with some planned surgeries being rescheduled.