About 70,000 NSW health workers are due to receive a $3500 pay boost despite significant opposition among union members.
The Health Services Union on Friday said the offer had passed with 54 per cent support of its members after being negotiated in lieu of a percentage increase.
By adding about $1.75 per hour to all workers' base rates, the increase will more than cover inflationary rises for lower-paid staff like hospital cleaners and ward people.
But higher-paid employees such as allied health professionals will see their wage rise less than the four-per-cent increase NSW Health initially offered.
Despite the division, union state secretary Gerard Hayes said solidarity and a strong sense of humanity underpinned the agreement.
"This agreement delivers an immediate, life-altering wage rise for workers on modest wages," he said.
"For people on higher classifications such as allied health, it unlocks thousands in salary packaging benefits and promises much more in the future through award reform and work value cases."
Members also endorsed the union kicking off a campaign from Monday calling for a tax grab involving workers' salary-sacrifice savings to stop more quickly than the government has planned.
It comes amid increased tension between unions and government employers over wages.
The 3000 workers keeping Sydney's drinking water and beaches clean have taken their first step towards strike action against Sydney Water.
Meanwhile, the NSW Teachers Federation has given the education department until Monday to complete award negotiations that began in April.
Premier Chris Minns on Friday conceded negotiations will be a rocky road but is confident the parties will arrive at a deal.
"There will be disagreement between the government and public sector unions that have got responsibility for workers," he said.
"We don't welcome it. But unfortunately, it will be part of the process."
The breakdown in talks at Sydney Water comes after management tried to slash pay and conditions and impose secretive, individualised, WorkChoices-style contracts on more than half of their employees, the union says.
"Long-term skilled workers are leaving and morale is at an all-time low," Australian Services Union deputy secretary Jan Primrose said on Friday.
The state-owned water provider said it had been bargaining in good faith and agreed to "a number" of the workers' claims.
Its offer of 11 per cent over three years (averaging 3.5 per cent annually) was still on the table.
The Minns government notched its first wages win last week after a deal for school support staff, prison officers and 80,000 other Public Service Association-aligned workers was formalised.
The government has offered all public sector workers a rise of four per cent backdated to July 1.
Nurses and midwives began voting on that offer and some changes to conditions this week.
