As debate heats up over ballot Question 1, which asks Massachusetts voters to adopt a law that would limit patient/nurse ratios in hospitals and other care facilities, leaders at the Martha’s Vineyard Hospital and Island nurses have joined the fray.

The Massachusetts Nursing Association, a union that represents 23,000 nurses statewide and all 112 nurses who work at the Martha’s Vineyard Hospital, supports the measure. But the question has faced vociferous opposition from most of the state’s hospitals and health care companies, including the Vineyard hospital and its parent company Partners HealthCare.

Statewide, the two sides have spent more than $20 million combined — the same amount as the Massachusetts gubernatorial campaign spending limit — on advertising campaigns meant to sway voters.

On the Island, nurses, the hospital and patients have engaged in the debate via signs, social media and more.

Question 1 proposes limiting the maximum number of patients per registered nurse, depending on the type of unit and level of care. The limits include a maximum of three patients per nurse in intermediate care units, five patients per nurse in psychiatric care units and one critical or intensive care patient per nurse in emergency services departments. The limits increase depending on the severity and circumstances of the emergency room patients.

Island nurses who support the ballot question cite overwork and patient safety as their main concerns.

“If a nurse has to take care of too many people, they’re stretched beyond their capacity,” said Richard Lambos, an Edgartown resident and former longtime hospital nurse who is retired. “That’s really the long and short of it.”

But the top administrator at the Island hospital said concerns about patient safety are unfounded, especially because of the high quality of the nurses who work there.

“Right now, we’re pretty well-staffed,” hospital president and chief executive officer Denise Schepici told the Gazette in a telephone interview Thursday morning. “I’m really proud of the nursing staff here . . . they are sensitive to the community’s needs and are well-seasoned to the sort of fluctuation we have. They’ve got it down.”

There are currently no government-mandated patient limits for nurses at the Vineyard hospital outside of man

datory ratios in the intensive care unit, hospital communications director Katrina Delgadillo confirmed. Information from the hospital website shows that the ICU ratio is roughly two nurses to one patient in the winter months and one nurse to two patients in the summer months, for a rough average ratio of one to one.

In a Facebook post, emergency room nurse Elizabeth Reid said she felt that voting yes on Question 1 would give her greater control over her work, putting the law on her side if she believes a situation is unsafe.

“We will be able to tell our administrators when we believe something is unsafe, and they have to respond,” Ms. Reid wrote. “All you need to do is ask yourself, ‘If you or a loved-one were a patient in a bed, who do you want caring for you? The nurse with 10 patients? Or the nurse with 3?”

According to a recent poll of the Massachusetts Nursing Association, 86 per cent of members support Question 1. The union represents about a quarter of all nurses in the state.

Ms. Schepici said the proposed law would exacerbate both the cost and difficulty of hiring new nurses at the 25-bed Vineyard hospital. She said Partners HealthCare believes the proposed ratios would cost the hospital $2.6 million annually and could potentially jeopardize the ability to staff Windemere, the Island’s only nursing home. Windemere is owned by the hospital and shares its campus.

“It’s equivalent to about 10 more nurses,” Ms. Schepici said, speaking of the actual impact if Question 1 is adopted. “That will not give us better care. Ten nurses is just adding costs. The scare tactic of we don’t have good quality is unfounded.”

She also said the proposed law would lure nurses away from smaller hospitals that are already difficult to staff, including the Island hospital, because it would increase demand.

“It’s hard to recruit nurses right now,” Ms. Schepici said. “This mandate would create such a ripple effect that will really hurt us . . . we already adjust wages for the cost of living on the Vineyard. This would create a food fight for wages.”

Ms. Schepici cited a recent study from the Massachusetts Health Policy Commission, an independent state agency that monitors health care spending, as evidence that government-mandated ratios will not improve quality of care. The commission came to that conclusion when studying California after the implementation of state-mandated nurse-patient ratios. The study also estimated that if Question 1 is adopted, it will cost the commonwealth and hospitals between $676 and $949 million.

Mr. Lambos said cost shouldn’t be a major concern, especially with the quality of patient care at stake. One billion dollars represents 1.6 per cent of the state’s total health care expenditure in 2017, and 3.5 per cent of total hospital spending, according to the HPC study.

“Ultimately, there is a dollar amount, there’s a cost,” he said. “But there’s money to be had. We didn’t need a new lobby, a Gone With the Wind Staircase, and a grand piano in the new lobby,” he said, referring to the Island hospital which saw its new building completed in 2010. “That could have gone to patient care.” Mr. Lambos, who worked at the Martha’s Vineyard Hospital for 37 years and in the emergency room for 18 of those years, said overwork was one of the reasons he retired. “It was a contributing factor,” he said. “I was getting older, and I just couldn’t deal with seven or eight patients. I could have dealt with three or four if I had to, but it doesn’t matter if you’re a 20-year-old nurse or a 50-year-old nurse.”

Voters will decide on Nov. 6.

“It’s going to be a touchy vote,” Mr. Lambos said.