Members of the Royal College of Nursing are to go on strike again after they voted against the latest government pay offer.

The result comes despite a recommendation from union leaders that they accept it and means there will be a round-the-clock 48-hour strike – without exemptions – from 8pm on 30 April to 8pm on 2 May.

The result comes despite Unison members voting in favour of the pay deal, on the grounds it was the “best that could be achieved through negotiation”.

For the first time, the Royal College of Nursing (RCN) strike will involve staff working in emergency departments, intensive care units, cancer care and other services that were previously exempt from industrial action.

More than six in 10 of eligible members took part in the ballot, with 54% voting to reject the government’s offer and 46% voting for it. Turnout was 61%.

RCN General Secretary Pat Cullen said she had written to the government to notify it of “imminent” strike action, as well as a new ballot and a request for a fresh round of talks.

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In a letter to Health Secretary Steve Barclay, Ms Cullen said what nurses had been offered was “simply not enough”.

“Since our talks in February, we have seen the pressures on the NHS continue to increase,” she said.

“Until there is a significantly improved offer, we are forced back to the picket line.

“After a historic vote to strike, our members expect a historic pay award.”

The development will come as a blow to the government, which hoped a settlement with nurses would pave the way for breakthroughs in other sectors gripped by industrial action.

Instead, there is the likelihood of further strikes over the summer months after teachers also voted to reject the government’s offer and junior doctors continue to strike in an increasingly bitter struggle over pay.

However, the government will be buoyed by the “decisive” Unison result, in which three quarters of 288,000 NHS workers across England voted to accept the offer.

Unison’s head of health, Sara Gorton said that while health workers “would have wanted more…this was the best that could be achieved through negotiation”.

Under the deal, Unison health workers will receive an additional one-off payment for the year 2022/23, along with a 5% pay rise for 2023/24 -10.4% for the lowest paid.

Unison, GMB and Unite the Union all also represent nurses in some capacity, as well as paramedics, 999 call handlers, midwives, security guards and cleaners.

According to the RCN, if the majority of members across all unions vote to accept the deal, then the government could still implement it.

A government spokesperson said: “It is hugely disappointing that the Royal College of Nursing membership has rejected the pay deal recommended by their leadership.

“Following constructive discussions, all parties agreed this was a fair and generous offer which is demonstrated by Unison, representing the largest share of the NHS workforce, choosing to accept it.

“The fact that the Royal College of Nursing has announced an escalation in strike action with no derogations, based on a vote from the minority of the nursing workforce, will be hugely concerning for patients.”

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The pay deal rejected by RCN members would have seen nurses awarded a one-off payment of 2% of their salary, plus a COVID recovery bonus of 4% for the current financial year and 5% for the year after.

Mr Barclay previously explained that, under the offer, a newly qualified nurse would have received more than £1,800 this year on top of a pay rise of more than £1,300 next year.

NHS Providers Director of Communications Adam Brimelow said The RCN vote was a “setback” and was “extremely worrying”.

“Trust leaders understand the frustration of nurses, junior doctors and other staff who have seen their pay fall behind inflation year after year.

“It’s really important that the unions and government find a way through this to prevent more strikes and let the NHS focus on its big challenges, including cutting waiting lists and transforming services, instead of having to resort to ‘all hands on deck’ just to get through the day.”

The nurses’ dispute is separate from the junior doctors row. Ministers have repeatedly insisted they will not enter into talks with the British Medical Association (BMA) until the union drops its demand for a 35% pay rise for junior doctors.