Nurses will be balloted on industrial action next month, if progress is not made on critical Emergency Department issues.
The Irish Nurses and Midwives Organisation says the system is at "breaking point".
It wants the HSE to engage with them on staffing levels, health and safety reviews in Emergency Departments and increased access to diagnostics for nurses.
The nationwide ballot of all members in Emergency Departments will take place in November if significant progress has not been made in four "critical areas".
Those areas are:
The unsafe staffing levels;
An immediate, independent health and safety review of each Emergency Department and of all Hospital Escalation Policies;
Increased senior clinical presence, to ensure acute assessment by senior clinical decision makers, and enhanced collaborative working, throughout the extended day, seven days a week, in all Emergency Departments;
Increased access, when required by nursing staff, to diagnostics seven days a week.
The INMO are asking for immediate discussions with health service management, and if no progress is made, they will start a nationwide ballot in the first week of November.
They will seek a mandate "for collective action up to and including the withdrawal of labour".
INMO General Secretary Liam Doran said: "It was quite apparent, from yesterday’s meeting with our ED Nurse Representatives, that they are beyond breaking point and they fear, constantly, for their patients and their own health and well-being.
"The four critical areas identified must now be the subject of immediate, positive and constructive, engagement which will address the critical issues of staffing, enhanced supports, senior clinical decision making and access to diagnostics.
"The INMO, in making this decision, is acutely aware that industrial action, in any area of the health service, should only be a last resort. However after 12 years of waiting for improvements, and unfulfilled promises, the time for action is now."
He said they have deferred the ballot to allow management show they are "serious in understanding the current crisis".