Abstract
Drawing on qualitative research in the main UK unions for nurses/midwives, this article investigates how union reps are responding on the ground to the realities and challenges confronting nursing and midwifery staff working in the English National Health Service (NHS). It confirms the difficulties encountered by public sector trade unions in maintaining and developing a resilient workplace unionism despite membership growth and organising efforts in highly feminised professions facing work pressures, increasing workload and staff shortages.