Barbara Mark, PhD, RN, FAAN
The University of North Carolina at Chapel Hill
School of Nursing
Carrington Hall, CB #7460
Chapel Hill, NC 27599-7460
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
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
Tubbs-Cooley, H., Pickler, R., Mara, C., Othman, M., Kovacs, A., & Mark, B. (2017) Hospital Magnet Designation and Missed Nursing Care in Neonatal Intensive Care Units, Journal of Pediatric Nursing.
Cho, S-H., Mark, B.A., Knafl, G. et al., (2017) Relationships between Nurse Staffing and Patients’ Experiences: The Mediating Effects of Patient-Reported Missed Nursing Care. Journal of Nursing Administration.
Tubbs-Cooley, H, Pickler, R., Mark, B.A., Carle, A. (2015). A research protocol for testing relationships between nurse workload, missed nursing care and neonatal outcomes: the neonatal nursing care quality study. J. Advanced Nurs. 71(3):632-641.
Song, L, Toles, M., Bai, J., Nielsen, M., Bailey, D., Sleath, B., Mark, B.A. (2015). Patient participation in communication about treatment decision-making for localized prostate cancer during consultation visits. Health; 7:1419-1429.
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. (2015). Improving couples’ quality of life through a web-based, couple-oriented prostate cancer education intervention. Oncology Nursing Forum; 42(2):183-92.
Bacon, C. T., Lee, S-Y., Mark, B.A. (2015). The relationship between work complexity and nurses’ participation in decision making in hospitals. Journal of Nursing Administration. 45(4):200-5.
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. 47(4):317-324.
Haynes-Maslow, L., Schramm, D., Mark, B.A, Ammerman, A., & Silberman, P. (2014). Stakeholder arguments in access to healthy food state-level legislation in newspapers and bill hearings, 2010-2012. Journal of Science Policy and Governance. September, Special Edition.
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, 71(4):813-824.
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.
Cho, S-H, Lee, J Y., Mark, B.A. & Jones, C.B. (2014). Geographic mobility of Korean new graduate nurses from their first to subsequent jobs and metro-nonmetropolitan differences in their job satisfaction. Nursing Outlook, 62:22–28.
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.
Cho, S.-H., Lee, J.Y., Mark, B.A., & Lee, H.Y. (2012). Geographical imbalances: Migration patterns of Korean new graduate nurses and factors related to working in non-metropolitan hospitals. Journal of the Korean Academy of Nursing. 42(7):1019-1026.
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. 45(4):701-711.
Mark, B.A., Harless, D.W., Spetz, J., Reiter, K., & Pink, G. California’s minimum nurse staffing legislation: Results from a natural experiment. (2012). Health Services Research. 48(2, Pt. 1): 435-454.
Principal Investigator: Jonas Nurse Scholars Program. Funded by the Jonas Center for Nursing and Veterans Healthcare. 2016 – 2019.
Principal Investigator: Robert Wood Johnson Future of Nurse Scholars. Funded by the Robert Wood Johnson Foundation. 2015 – 2019.
Co-investigator: Nurse certification and infant outcomes in neonatal intensive care. Funded by the American Nurses Credentialing Center Clinical Research Grant and the Stryker Medical Research Award. 2015 – 2016.
Mentor, Jia-Rong Wu (Principal Investigator). An integrated, family-focused and literacy sensitive intervention to improve medication adherence in patients with heart failure. Funded by the National Institute of Nursing Research. 2013 – 2016.
Core Faculty: Cecil G. Sheps Center for Health Services Research Training Program for Health Services Research. Funded by the Agency for Healthcare Research and Quality. 2013 – 2018.
- Organization and delivery of care in acute care health systems
- Using large secondary databases
- Longitudinal methods in organizational research