Unison joined the Royal College of Nursing in accepting the offer, worth 8 per cent over three years.
The union balloted 452,000 NHS workers. Just under two-thirds voted in favour.
The deal is set to be formally accepted for all NHS staff in England and Wales except doctors and dentists, despite smaller unions such as Unite and GMB voting against it.
Health secretary Alan Johnson said the deal was fair, offered security to staff and was "good news for the stability of our economy".
But Unison said it would not hesitate to use a "reopener clause", by which it can request to negotiate, if staff recruitment and retention suffer and inflation keeps rising.
"If food and fuel prices continue to go up, we will be knocking on government's door to reopen this issue," said Unison lead negotiator Mike Jackson.
More than 90 per cent of RCN members backed the deal, which includes a 2.75 per cent pay increase this year and a new£6.77 minimum wage in the second year.
The offer was also endorsed by the Society of Radiographers, Community and District Nursing Association and Managers in Partnership.
The Royal College of Midwives and Chartered Society of Physiotherapy were among unions that rejected the offer.
Over 96 per cent of GMB members voted against.