BOSTON — After an expensive campaign that sharply divided health care professionals, Massachusetts voters have rejected strict limits on the number of patients a single nurse can care for at one time.

The ballot question would have established nurse-to-patient ratios in various hospital units and set penalties for hospitals that failed to comply.

The Massachusetts Nurses Association supported the question, while hospitals and doctors' groups opposed it. The two sides combined had spent more than $30 million to make their case to voters.

Supporters said the nurse staffing requirements would make patients safer, but opponents said it would create an overly rigid system that could result in hospitals being forced to turn away some patients.

California is the only other U.S. state with mandated nurse-to-patient ratios.

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