Underpaid and undervalued despite being the backbone of Australia’s largest health system, nurses and midwives in NSW are to get a substantial pay rise.

The state’s independent Industrial Relations Commission found the nearly 70,000 employees were entitled to a pay bump over three years, with a significant hike in the first year backdated to July 2025.

“The work of nurses, midwives and assistants in nursing are currently undervalued, and they deserve as a result a one-off increase,” commission president Justice Ingmar Taylor said on Thursday.

“They are essential, integral and irreplaceable to the system’s function and effectiveness.”

Over three years, registered nurses and midwives will get 16 per cent, 18 for enrolled nurses, and a whopping 28 per cent for nursing assistants.

The two subsequent years of the agreement will bring 3 per cent annual increases.

The last major arbitration of nursing wage rates was more than two decades ago.

Health Minister Ryan Park said it was a “really positive day for NSW healthcare workers.”

But reaction from the NSW Nurses and Midwives’ Association was not overly jubilant.

“Today’s announcement gives a historic record-breaking pay deal … but registered nurses and midwives remain behind those in other states,” the union’s head Michael Thwaites said outside the commission.

Annual salaries for registered nurses in the state start the $87,000 mark which falls well behind nation-leading ACT at $103,000 followed by Queensland at $94,000 and Western Australia $91,000.

Nurses and midwives make up about half of all employees of the NSW health service. Of them, 90 per cent are women.

Taylor said the gendered nature of the profession was a factor in how employees had been financially overlooked for decades.

“Nurses and midwives perform invisible skills and there is at least a real possibility that their work is undervalued for gender reasons,” he said.

For midwife Christie, the commission’s recognition was well-received but did not go far enough with the figures falling short of the union’s demands of a 35 per cent increase.

“As a mother raising two girls here in Sydney – it’s tough,” she said.

“We’re just looking for more from this government and we won’t stop asking for it. We deserve it.”

NSW Treasurer Daniel Mookhey hailed the decision, which took two years from the start of arbitration, as a “fair outcome for all parties” trumpeting changes the Labor government ushered in by re-instating the independent labour umpire.

“No one got everything they wanted here,” he said.

He said the upcoming NSW budget would be able to handle the billions to be paid out to the nurses and midwives without specifying a dollar amount.

The annualised workforce cost is about $7.5 billion.

“Nurses and midwives are the DNA of the NSW health system,” Taylor said in his judgement.

-AAP