Healthcare managers trade union Managers in Partnership (MIP) has "reluctantly" accepted the government's final offer for its proposed NHS pensions reform.
Less than a quarter (22%) of MIP members took part in the ballot.
Of those voting, 78% chose to accept the pension offer and 22% voted to reject.
MIP Chief Executive Jon Restell said while members were "reluctant" to accept the government's pension reform, they were being "realistic" in doing so.
"In voting, MiP members were reluctant to accept the offer but realistic about the prospects of getting something better without sustained industrial action," he said.
"In meetings up and down the country, managers have voiced their frustration at these unnecessary changes to the pension scheme."
Restell said some "key concerns" such as the raising of NHS workers' pension age and the widening of the pension scheme are "subject to further discussions".