The state government could be hauled before the Tasmanian Industrial Commission unless a special panel is appointed to resolve workload issues in the Launceston General Hospital's emergency department.
The Australian Nurses and Midwifery Federation's state branch issued the ultimatum on Monday, claiming bed block at the hospital would not be sorted out with the current nurse staffing levels.
Union secretary Emily Shepherd said members were worried many skilled nurses would leave the hospital if its issues were not addressed soon.
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She said the union was also wary of the promise of additional staff.
"They know there will be a long wait, because the Tasmanian Health Service has a long history of taking months if not years to sign off on additional staffing, despite nursing staff continuing to work in unsafe environments," Ms Shepherd said.
She said the hospital required a staffing ratio of one emergency department nurse to three patients.
Labor leader Rebecca White said nurses had been put under extraordinary pressure this year like all health workers.
"At the LGH, they haven't been provided with any addition resources to do with the extra pressure because the Mersey Community Hospital emergency department has reduced its hours," she said.
A government spokesperson said there had been a staffing increase of more than 100 full-time-equivalent positions at the hospital in the past 12 months.
This included 26 more nurses.
They said a permanent patient-flow team had been implemented, which included after-hours nurse managers and a full-time nursing director.
The spokesperson said the North-West community could be assured the government was committed to reopening the Mersey's emergency department on a 24-hour basis.
"We are taking immediate action under our plan for the Mersey ED - providing more resources to the ED, implementing immediate staffing solutions, and bolstering our recruitment efforts," they said.
"The head of the state service has recently approved the payment of a market allowance for THS employees from other regions taking up short-term positions in various areas in the North-West region"
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