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Barbara Mark, PhD, RN, FAAN

Director, PhD and PostDoctoral Programs and Sarah Frances Russell Distinguished Professor

Phone: (919) 843-6209
Specialty Area: Systems/Policy/Informatics

The University of North Carolina at Chapel Hill
School of Nursing
1301 Carrington Hall, CB #7460
Chapel Hill, NC 27599-7460

Office: Carrington Addition 1301

Dr. Mark has been involved for more than 25 years in the study of work environments, quality and safety in acute care hospitals.


  • N928: Organizational Theory Applied to Nursing
  • N933: Health Care Quality and Patient Outcomes: Conceptual and Methodological Approaches
  • Overview

    The relationship between the management and delivery of acute care nursing and patient outcomes has long been of interest to nurse health services researchers. I conducted 2 NINR-funded multisite longitudinal studies to test a theoretical model of nurse, organizational, and patient outcomes. These projects were innovative in their use of 67 and 143 acute care hospitals (respectively), providing one of the largest datasets available to examine such a theoretical model. In addition, our model was a comprehensive, multi-level model, which allowed us to investigate not only management processes on nursing units, but the interaction of those management process with larger hospital and external environmental influences. We introduced into the literature the use of multi-level structural equation modeling, and autoregressive latent variable modeling to study specific relationships.

    A second area of concern to nurse health services researchers has been the study of the relationship between nurse staffing and patient outcomes. In a series of 3 studies, funded by AHRQ, my research team introduced advanced econometric techniques that overcame the limitations of prior studies, which tended to demonstrate inconsistent, but generally linear relationships between staffing and outcomes. We expanded the outcomes of interest to include hospital financial performance and the delivery of uncompensated care. Our studies found non-linear relationships between staffing and selected outcomes, and much more complicated relationships than previously had been found. For example, in our analysis of the effect of minimum nurse staffing legislation in California (the only state in the US with such legislation), we used a difference-in-difference model, and found that patient mortality decreased in California relative to other states where there was no staffing legislation, but the improvement was seen only in hospitals with the lowest levels of staffing prior to that legislation. The “take home” message of our studies has been that nurse staffing is an important contributor to patient outcomes, but under a somewhat limited set of circumstances

2014 Award Selection Committee, Friends of the National Institute of Nursing Research

2013 Friends of the National Institute of Nursing Research PathPaver Award

2011 Visiting Professor, Hadassah University, Jerusalem, Israel

2010-2011 Visiting Professor, New York University

2010-2011 Carrington Leave

2011 Excellence in Doctoral Mentorship and Education Award presented by PhD students at University of North Carolina at Chapel Hill School of Nursing

2010 Research Mentor of the Year Award, Interdisciplinary Research Group on Nursing Issues, AcademyHealth


Haynes-Maslow, L., Schramm, D., Mark, B.A, Ammerman, A., & Silberman, P. Stakeholder arguments in access to healthy food state-level legislation in newspapers and bill hearings, 2010-2012. Journal of Science Policy and Governance.


Song, L., Rini, C., Deal, A.M., Nielsen, M.E., Kinneer, P., Teal, R., Johnson, D.C, Dunn, M.W., Mark, B. A., & Palmer, M.H. Improving couples’ quality of life through a web-based, couple-oriented prostate cancer education intervention. Oncology Nursing Forum, 42(2):183-92.

Haynes-Maslow, L., Ammerman, A. & Mark, B.A.  (2015) Low-income individuals' perceptions about fruit and vegetable access programs: A qualitative study. Journal of Nutrition Education and Behavior Apr 21. pii: S1499-4046(15)00081-0. doi: 10.1016/j.jneb.2015.03.005. [Epub ahead of print]

Bacon, C. T., Lee, S-Y., Mark, B.A.  The relationship between work complexity and nurses’ participation in decision making in hospitals. Journal of Nursing Administration. 2015 45(4):200-5.

Tubbs-Cooley HL, Pickler RH, Mark BA, Younger JB. (2014). A descriptive study of missed nursing care in neonatal intensive care units, Journal of Advanced Nursing. Early view December 1.

Tubbs-Cooley, H L., Pickler, RH, Mark, BA, Carle, AC; & Kotagel, U. (2014). A research protocol for testing relationships between nurse workload, missed nursing care, and neonatal outcomes: The Neonatal Nursing Care Quality Study, Journal of Advanced Nursing Article first published online: 29 OCT 2014 DOI: 10.1111/jan.12507

Kang, J-H, Weber, D.J. & Mark, B.A. (2014). Survey of North Carolina Hospital Policies Regarding Visitor Use of Personal Protective Equipment for Entering the Rooms of Patients on Isolation Precautions. Infection Control and Hospital Epidemiology 35(3):259-264.

Spetz, J., Harless, D.W. & Herrera, C. & Mark, B. A. (2013). Using California’s minimum staffing legislation to investigate the relationship between nurse staffing and quality of care. Medical Care Research and Review. 70(4):380-99.

Lindley LC, Mark BA, Lee S-Y, Domino M, Song M., & Vann J. (2012). Factors associated with the provision of pediatric hospice care. Journal of Pain and Symptom Management.  Epub ahead of print. August 23.

Mark, B.A., Harless, D.W., Spetz, J., Reiter, K., & Pink, G. (2013) California’s minimum nurse staffing legislation: Results from a natural experiment.  Health Services Research.  48(2 Pt 1):435-54.

Gates, M., & Mark, B.A. (2012). Demographic diversity, value congruence, and workplace outcomes in acute care. Research in Nursing and Health. 35(3):265-276.

Cho, S.-H & Mark, B.A. Turnover of New Graduate Nurses in their First Job Using Survival Analysis, (2012).  Journal of Nursing Scholarship. 44(1):63-70.

Reiter, K., Harless, D., Pink, G. & Mark, B.A.  (2012). The effects of minimum nurse staffing legislation on financial performance of California hospitals. Health Services Research. 47(3): 1030-1050.

Mark, B.A., & Harless, D.W. (2011). Adjusting for patient acuity in the measurement of nurse staffing:  two approaches. Nursing Research. 60(2):107-114.

Chang, Y.K. & Mark, B.A.  (2011). Effects of learning climate and registered nurse staffing on medication errors.  Nursing Research, 60(1): 32-39; reprinted in Journal of Nursing Administration, 41(7-8); S6 – S13 (2011).

Cho, S.-H., Mark, B.A., Yun, S.-C., Joon, K. J. (2011). Differences in intensive care unit work environments among and within hospitals using subscales and a composite measure of the revised nursing work index,  Journal of Advanced Nursing. 67(12): 2637-2648.

Reiter, K., Harless, D., Pink, G., Spetz, J., & Mark, B. A. (2011). The effect of minimum nurse staffing legislation on uncompensated care provided by California hospitals,  Medical Care Research and Review.68(3):332-351.

Ongoing Research Support  

NINR 2T32NR08856 Research Training: Healthcare Quality and Patient Outcomes (2004 – 2015)

Cincinnati Children’s Hospital; Heather Tubbs Cooley, PI (2012 – 2015) Research Scholar in Patient Services Award Missed Nursing Care and Infant Outcomes in the Neonatal Intensive Care Unit Role:  Mentor

NINR K23NR014489  Jia-Rong Wu PI (2013 – 2016).

An integrated family-focused and literacy sensitive intervention to improve medication adherence in patients with heart failure. Role:  Mentor

Pending Research Support

NINR R01016036-01 Lixin Song PI (2015 – 2019).

A Couple-Focused, Tailored mHealth Program For Prostate Cancer Symptom Management Role: Co-investigator