Thousands of paramedics, hospital cleaners and allied workers have walked off the job across NSW, demanding higher pay after two years of tough working conditions during the pandemic.
The Health Services Union (HSU) wants the 2.5 per cent public sector wage cap to be lifted and to renegotiate awards for its members.
It has warned if it cannot come to an agreement with the state government, then Thursday's industrial action will be the start of a long list.
"The law has to be changed," HSU secretary Gerard Hayes said.
"This isn't just a matter of changing the rules. We are serious about this law, which is draconian, which does not support the additional skills, education, qualifications that people have in 2022.
"It deals with issues from 1990 and we're not prepared to deal with it anymore."
For months, the state government has hailed health workers as heroes and recognised the work they have been doing in hospitals.
The union is pushing for a 5.5 per cent pay rise to combat the rise in inflation and cost of living.
Mr Hayes said the HSU's 25,000 members wanted more than just lip service.
"Our members are used to stand-up comedy and that's what they see it as," he said.
"It's disingenuous. They know it's not real.
"At this point in time they're not taking those platitudes anymore."
Tess Oxley, who has worked as a paramedic for 12 years, says the fatigue from the job has colleagues looking for new careers.
"The odd time we do get to sit down and chat, they're chatting about which different pathways they're looking at and what the next way out is," the 38-year-old said.
"We haven't actually had a break, we haven't had a chance to stop and reflect on exactly what we have done in the last two years.
"I don't think we get any recognition from the government … the government seem to think if they say thanks to us on a bad day it's enough, and it just isn't enough anymore."
Lauren McKenzie works as an administration ward clerk at South East Regional Hospital in Bega, on the NSW far south coast, and is a member of the HSU.
The 31-year-old said the rising cost of living was increasing financial pressure on healthcare workers and they desperately needed a pay increase.
"The pay rise would be excellent for living down in this region with how expensive things are," she said.
"[It's expensive] not only for someone my age but also for people just starting out of school. The pay is just not right.
"And [the staff's] safety is at risk. Everyone's safety is at risk right now."
Across NSW, health staff engaged in stop-work meetings for up to four hours.
Hospital patients experienced some delays but ambulances still responded to serious and life-threatening emergencies.
"The steps we've taken today have been responsible … no patient has been adversely affected," Mr Hayes said.
NSW Premier Dominic Perrottet said he believed the issue would be resolved with the union.
"If we can do more we will," he said. "We're assessing that, we're working with the unions and their needs.
"It's got to be balanced with budgetary pressures we're under … our salaries in the public sector are paid for by the taxes of those people who work in the private sector.
"We have over 10 years at 2.5 per cent, had wage growth that exceeded the private sector and exceeded the rate of inflation here in New South Wales."
This was the third health-related strike in two months. Thousands of nurses and midwives walked off the job for 24 hours last week over low wage growth and staff-patient ratios.
