On 16 April, the NSW Industrial Relations Commission handed down the biggest pay decision for any group of workers in the state in more than 20 years.
Registered nurses and midwives: 16% over three years.Enrolled nurses: 18%.Assistants in nursing: 28%.
Backdated to July 2025. Roughly 70,000 workers affected.
It's a pay rise that was a long time coming. Nurses and midwives have carried the system through a pandemic, rising patient acuity, chronic understaffing and years of wage caps that held their pay below inflation. The Commission's decision is recognition of work that has been quietly propping up the health system for decades.
But the ruling also reshapes the landscape for every healthcare employer in the country, not just NSW public hospitals. Here's what's actually in it, and why it travels.
What the Commission found
Three findings matter beyond NSW.
Gender undervaluation was named directly. Ninety per cent of the nursing and midwifery workforce is women. Justice Ingmar Taylor said nurses and midwives "perform invisible skills and there is at least a real possibility that their work is undervalued for gender reasons." That language is now on the record. Future cases in other states will cite it.
The work itself has changed. Higher acuity, more complex patients, more responsibility pushed down the clinical chain. The Commission accepted that the old pay scales were set against a job that no longer exists.
NSW had fallen behind nationally. Registered nurse salaries started around $87,000 in NSW, against $103,000 in the ACT, $94,000 in Queensland and $91,000 in WA. The reset was, in part, a correction.
What it means for Australian healthcare employers
The most immediate effect is on the NSW public system itself. Roughly 70,000 workers receive backdated pay, and NSW midwives, registered nurses and enrolled nurses at the top of the scale are now the best paid in the country.
Beyond NSW, the ripples are harder to ignore.
Private hospitals, aged care, community health, GP clinics and mental health services all recruit from the same workforce pool as NSW Health. When the public system repositions itself at the top of the pay table, the market rate for nurses shifts with it. Employers who had been closing retention gaps with flexibility or culture will find those levers pulling less weight against a 16-28% pay increase.
Other states will feel the pressure next. The ruling gives unions in every jurisdiction a template: argue gender undervaluation, benchmark against NSW, and point to workforce shortages as evidence the old rates don't reflect the work. Queensland, Victoria and WA all have active nursing workforce pressures and enterprise agreements that will be renegotiated in the coming years. NSW Treasurer Daniel Mookhey has already described the cost as "significant." Other treasuries will be watching closely.
Aged care is particularly exposed. AINs received the biggest rise at 28%, and they are the backbone of residential aged care. The Fair Work Commission's Aged Care Work Value Case has already delivered cumulative increases of up to 28.5% for direct care workers and 17.9-23% for AINs under the Nurses Award since 2023. The NSW decision adds more pressure to an already shifting cost base.
The bigger picture
For twenty years, public sector wage caps in several states held nursing pay artificially low. The Industrial Relations Commission has now explicitly named gender undervaluation as a factor in that, and workforce shortages have given unions the leverage to press the argument. The workforce itself also has more options than it used to, with more nurses moving interstate, into agency work, or out of the profession altogether.
Whether the NSW ruling proves to be a one-off correction or the start of a national repricing of nursing labour will depend on what happens in the other states over the next 18 months. Either way, the baseline has moved.
The nurses got a pay rise they've earned. The sector got a new set of numbers to work with.
HealthX works with healthcare employers across Australia on clinical workforce strategy, recruitment and retention. Get in touch to talk about what this means for your team.
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