Nurses in the United Kingdom have reached breaking point. As many as 100,000 members of the Royal College of Nursing will walk out across England, Wales and Northern Ireland on Thursday in the first of two days of strikes this month to protest poor pay and working conditions. They plan to walk out again on December 20. (Nurses in Scotland are negotiating a separate pay offer.) It’s the first time in its 106-year history that the RCN — the UK’s biggest nursing union — has gone on strike in England. The action has been sparked by a cost-of-living crisis that has slashed nurses’ spending power nearly three years after the start of a pandemic that pushed many to their limits. “It is pretty unprecedented,” Billy Palmer, senior fellow at Nuffield Trust, a health research firm, told CNN. While small pockets of nursing staff have walked out before, the country’s National Health Service has seen “nothing of this scale until now,” he added. That is partly because, for most of its history, the RCN had a “no strike” policy. In 1995, the union changed its rules, allowing strikes as long as they did not compromise patient care. “Patient safety is always paramount,” the RCN says on its website, adding that some nursing staff would continue to work through the strike. The RCN has promised to maintain critical services, including chemotherapy and dialysis treatments, during this month’s stoppages. The nurses join hundreds of thousands of other British workers who are striking this December, including rail staff, postal workers and ambulance drivers. At the center of these disputes is pay, which is failing to keep pace with inflation that hit a 41-year high of 11.1% in October. It is the broadest wave of industrial unrest since the country’s infamous “winter of discontent” in the late 1970s, when huge numbers of workers, from truck drivers to gravediggers, went on strike. The chaos has prompted Prime Minister Rishi Sunak to warn that “tough” new laws restricting strike action are on their way. ‘Enough is enough’ Earlier this year, the RCN rejected an offer by the government to increase nurses’ pay by a minimum of £1,400 ($1,707) a year. The offer amounted to an average rise of 4.3%, well below the rate of inflation. Pat Cullen, RCN general secretary and chief executive, said last month that “enough [was] enough,” and that nurses would “no longer tolerate a financial knife-edge at home and a raw deal at work.” The union says it wants a 19% pay rise — a 5% uplift on inflation of 14%, as measured by October’s retail price index — and for the government to fill a record number of staff vacancies that, it argues, is jeopardizing patient safety. The RCN knows that’s optimistic, Palmer said. Nurses are not “genuinely holding out” for such a increase, he said, but are simply using it as a starting point for negotiations. But that demand is “not affordable,” Steve Barclay, the UK’s health secretary, told CNN in a statement. Each additional 1% pay rise for nursing staff would cost the government around £700 million ($854 million), he added. Barclay said on Twitter last month that industrial action would “inevitably” impact services, but that the NHS had “tried and tested plans in place to minimize disruption and ensure emergency services continue to operate.” ‘Years of underinvestment’ The dispute has its roots in previous grievances. The 360,000 nurses who work for the NHS — the service’s largest professional group — have suffered from years of underinvestment, the RCN argues. In 2010, the Conservative-led coalition government embarked on a decade of austerity to stabilize the country’s finances following the global financial crisis. Nurses’ pay dropped 1.2% every year between 2010 and 2017 once inflation was taken into account, according to The Health Foundation, a UK charity that campaigns for better health and health care. For the first three of those years, their pay was frozen. Despite pay increases in the years since, the Nuffield Trust estimates that the typical nurse’s salary — around £40,000 ($49,000) for experienced nurses working full time — has fallen by almost 6% after inflation compared to a decade ago. That compares to a 0.6% rise in private sector pay over the same period. Internationally, it is hard to compare UK nurses’ pay, given health care systems differ significantly between countries, but it falls somewhere in the middle of the range of comparable economies, Palmer said. “Almost any way you cut it we’re pretty much in the middle, typically [we] look a bit worse than Germany but a bit better than France, and we certainly look worse than the Anglosphere, like Australia and the United States,” he said. That is also true for overall spending on the NHS. While the government has increased funding in the past decade, the gains have been “marginal,” according to Palmer. Once inflation and demographic changes are factored in, spending in England has risen by just 0.4% per year since 2010, Nuffield Trust data shows. ‘Emotionally draining’ Pay is not the only problem. Nurses are also burned out, partly because there are a record 47,000 vacancies in England. Nuffield Trust data shows that 40,000 nurses in England, or about 11% of the total nursing workforce, quit their jobs in the year to June. A similar number joined — almost 45,000 — but it was not enough to fill the gaps. Most nurses left to retire, but the number citing work-life balance, the second most common reason to leave, is nearly four times higher than a decade ago. And more could quit if conditions don’t improve. An RCN survey of its members last December showed that 57% of respondents were considering leaving. Feeling undervalued and working under too much pressure were the main reasons given. Sally Warren, director of policy at The King’s Fund, a think tank, told CNN that the past decade had been “challenging” as staff numbers had trailed behind demand. The pandemic only intensified those problems. “[Nurses were] having to manage the iPad call between someone who [couldn’t] be visited by relatives in their final hours,” Warren said. “[It was] really emotionally draining.” — Zahid Mahmood contributed reporting.