Editor's note: I've never had as many people ask me how to vote as I have in the recent run-up to Question 1, the state ballot measure on nursing ratios. That surely goes at least tenfold for nursing workforce researcher Karen Donelan. She wrote this post for family members and friends on Facebook to answer their queries, but agreed when CommonHealth asked her permission to re-post it here, lightly edited. — Carey G.

I have two daughters: One is a nurse practitioner, the other a nursing student. I work at a large Massachusetts hospital and have a doctoral degree in health policy and management with a focus on institutional and political analysis.

I've been doing nursing workforce research since 1995 with some of the leading nurse researchers, labor economists and quality researchers in the country — many of whom have been involved in analyses of Question 1 on both sides. I work with, and am friends with, nurses who support and who oppose this initiative.

So I have personal and academic interest, some conflicts of interest and one kind of expertise to lend on this question.

Here are some things I think and believe about Question 1:

1. Staffing levels at some hospitals and other facilities in our state are almost certainly unsafe at some times. This is especially true at many hospitals that care for the most vulnerable populations in our state, including adults and children with physical and mental health disability, and people who are poor. I worry the most about these hospitals and facilities, some of which are very small or in remote places.

2. As a state, we are very lucky. Our hospitals generally have nurse salaries and quality measures that exceed those in most other states. We have a very low rate of uninsured people. We have outstanding clinicians, scientists, social services and more.

3. Comparing Massachusetts and California on these issues is not helpful. Yes, they have a law, passed in 1999 — a time when a quarter of their population lacked health insurance. California's population is hugely diverse — racially, ethnically and geographically — compared to ours. The data on changes in the quality of care in California since their law came into effect are inconclusive, but our state exceeds them in many ways, then and now. Health care is so different now from when California passed their law. Most importantly, their law allowed time — five years! — for implementation, was developed in the legislature, and was written more carefully. This is not California.

4. The advertising on both sides of these issues has been terrible. In my opinion, both sides have stretched the truth and even flat-out lied about some of the research underlying their claims. Both have resorted to ugly scare tactics. Both sides should be ashamed.

5. There is absolutely no doubt that this law would raise costs in our health system. Estimates vary, but you cannot add staffing and not raise costs. That may be OK with everyone, but should we spend our estimated new $500 million to $1 billion on RNs?

I believe our system needs more staffing, especially for the more vulnerable patients, but I would prefer to see that staffing include community-based nursing, social services, community health workers, physician assistants and nurse practitioners, home services for frail elders, and recovery and treatment support for people with addiction. The future of care for those populations is in the community, not the hospital. If we shift these personnel to the hospital, which will certainly happen, we will not have them in the community.