EXHIBIT 3.

Changes in hospital nurses’ reports on patient safety, by type of change in the clinical work environment in hospitals from 2005 to 2016

	Change in percent of nurses
		Hospitals in which the clinical work environment:
Indicator	All hospitals (N= 535)	Worsened (n= 39)	Remained the same (n= 381)	Improved (n= 115)
GLOBAL MEASURES
Quality of patient care is excellent	4	−16	2a	15b,c
Favorable grade on patient safety (A or B)	2	−19	0a	15b,c
CULTURE OF PATIENT SAFETY INDICATORS
Staff do not feel like mistakes are held against them	−9	−26	−10a	0b,c
Important information is not lost during shift changes	−8	−19	−9a	0b,c
Things do not fall between the cracks	−7	−20	−8a	1b,c
Staff feel free to question authority	3	−15	1a	13b,c
Patient safety is a top priority of management	−4	−25	−6a	7b,c
RELATED MEASURES
Job satisfaction	7	−8	6a	16b,c
Low score on Maslach Burnout Inventory	3	−9	1a	12b,c

SOURCE Authors’ analysis of data for 2015–16 from the RN4CAST-US Nurse Survey.

NOTES Hospital nurses were staff registered nurses (RNs) in 535 hospitals; see the exhibit 1 notes. The threshold for significance is 0.05.

^aSignificant difference between the change in hospitals whose work environments remained the same and that in hospitals whose environments worsened.

^bSignificant difference between the change in hospitals whose work environments improved and that in hospitals whose environments worsened.

^cSignificant difference between the change in hospitals whose work environments improved and that in hospitals whose environments remained the same.