National Athletic Trainers' Association Position Statement: Facilitating Work-Life Balance in Athletic Training Practice Settings

Multistakeholder Perceptions of Young Professionals' Integration During Role Transition

CONTEXT

The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time, but no studies with multiple stakeholder groups have been completed.

OBJECTIVE

To examine the perceptions of EPs' integration during role transition from multiple stakeholder groups.

DESIGN

Qualitative study.

SETTING

Online interviews.

PATIENTS OR OTHER PARTICIPANTS

Seventeen EPs in the first 2 years of their first job postcertification (9 women, 8 men, age = 26 ± 5 years, experience = 9.5 ± 5 months), 16 supervisors and mentors of EPs (6 women, 10 men, age = 52 ± 11 years), and 10 faculty members and 8 preceptors (11 women, 7 men, age = 43 ± 10 years).

DATA COLLECTION AND ANALYSIS

Semistructured interviews using a validated interview guide based on the current literature were conducted. We analyzed data using consensual qualitative research principles. Multiple-analyst triangulation (n = 3), member checking, and peer review served as trustworthiness strategies.

RESULTS

We identified 4 themes that defined the integration of EPs during role transition. The integration of EPs was facilitated through role inductance and mentoring. Early professionals struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years.

CONCLUSIONS

Early professionals benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support are needed during the initial few years to ease EPs' role inductance while they gain more experience and establish their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.

Work-Family Conflict and Family Role Performance Among Collegiate Athletic Trainers

CONTEXT

Work-life balance continues to be a focal point of athletic training research, particularly due to the job challenges and demands of health care providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance (FRP).

OBJECTIVE

To examine the relationships between work-family conflict (WFC), FRP, and various demographic variables among athletic trainers employed in the collegiate setting.

DESIGN

Cross-sectional online survey.

SETTING

Collegiate setting.

PATIENTS OR OTHER PARTICIPANTS

A total of 586 collegiate athletic trainers (females = 374, males = 210, sex variant or nonconforming = 1, preferred not to answer = 1).

MAIN OUTCOME MEASURE(S)

Data were collected through an online survey (Qualtrics) in which participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptive information and frequencies. Mann-Whitney U tests were performed to identify differences among groups.

RESULTS

Participants' mean scores were 28.19 ± 6.01 and 45.86 ± 11.55 for the FRP and WFC scales, respectively. Mann-Whitney U tests revealed differences between men and women for WFC scores (U = 344 667, P = .021). The FRP score was moderately negatively correlated with the WFC total score (rs[584] = -0.497, P < .001) and predicted the WFC score (b = 72.02, t582 = -13.30, P = .001). The Mann-Whitney U test demonstrated that married athletic trainers (47.20 ± 11.92) had higher WFC scores than those who were not married (43.48 ± 11.78; U = 19847.00, P = .003). Mann-Whitney U analysis (U = 32 096.00, P = .001) also revealed a difference between collegiate athletic trainers with children (48.16 ± 12.44) and those without children (44.68 ± 10.90).

CONCLUSIONS

Collegiate athletic trainers experienced more WFC with marriage and having children. We propose that the time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to be able to spend time with their families; however, when such time is highly limited, then WFC increases.

Lessons Learned and Potential Long-Term Effects on Athletic Trainers and Clinical Practice After a Global Pandemic

CONTEXT

Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care.

OBJECTIVE

To explore the influence of COVID-19 stressors on ATs engaged in patient care.

DESIGN

Cross-sectional study.

SETTING

Internet survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care.

MAIN OUTCOME MEASURE(S)

We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies.

RESULTS

Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession.

CONCLUSIONS

Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.

Mindfulness Matters: Use and Perceptions of Mindfulness Practices Among Athletic Trainers

CONTEXT

Mindfulness practices are effective for injury or illness recovery, decreasing stress and anxiety, and strengthening emotional resilience. They are also beneficial for health care professionals' wellbeing and improving patient outcomes and safety. However, mindfulness has not been studied in athletic trainers.

OBJECTIVE

To investigate athletic trainers' use of mindfulness practices and their perceptions of its importance for self-care and patient or client care.

DESIGN

Cross-sectional study.

SETTING

All athletic training practice settings.

PATIENTS AND OTHER PARTICIPANTS

A total of 547 athletic trainers who were currently practicing completed the survey.

MAIN OUTCOME MEASURE(S)

We developed an 18-item survey that measured use (1 = never to 6 = very frequently) and perceptions (1 = strongly disagree to 7 = strongly agree) of mindfulness practices. Mann-Whitney U or Kruskal-Wallis tests with post hoc pairwise comparisons were performed to assess differences in use (P < .05). A related-samples Wilcoxon signed rank test was calculated to assess differences in participants' perceptions between self-care and patient or client care.

RESULTS

Overall, 86% (n = 471) of respondents reported involvement in some form of mindfulness practice, with females (median [interquartile range] = 4 [2-5] versus males: 3 [2-4]; P < .002), those not in a committed relationship (4 [2-5] versus those in such a relationship: 3 [2-4]; P = .048), and those without children in the home (4 [2-5] versus those with children in the home: 3 [2-4]; P = .040) describing the highest frequency of use for self-care. Females (4 [2-4] versus males: 3 [2-4]; P < .001), those without children in the home (3 [2-4] versus those with children in the home: 3 [2-4]; P = .036), and those in emerging (4 [2-4]; P = .003) or collegiate (3 [2-4]; P = .006) settings most frequently incorporated mindfulness into patient or client care. Overall frequency of use for self-care was higher than for patient or client care (4 = occasionally [2-4] versus 3 = rarely [2-4]; P < .001). Mindfulness practices were perceived as more important for self-care than for patient or client care (6 [5-7] versus 5 [5-6]; P < .001).

CONCLUSIONS

Athletic trainers perceived mindfulness practices as more important for personal wellbeing and used them, albeit occasionally, more for self-care than for patient or client care. Differences in gender, relationship status, children, and setting were observed. Mindfulness-based interventions for athletic trainer wellbeing and patient-centered care and implementation barriers should be explored.

Parental Perspectives of Work-Family Conflict and Guilt in Collegiate Athletic Trainers: A Descriptive Qualitative Design

CONTEXT

Work-family guilt has been reported among athletic trainers (ATs) working in the intercollegiate setting; however, it has yet to be fully explored from a descriptive, in-depth perspective.

OBJECTIVE

To better understand the experiences of work-family conflict and guilt of intercollegiate ATs who are parents.

DESIGN

Descriptive qualitative study.

SETTING

Intercollegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

Twelve collegiate ATs (females = 6, males = 6) participated in the study. All 12 were married (12 ± 7 years) with an average 2 ± 1 children (range = 1-4). The ATs reported working 51 ± 9 hours per week and spending 11 ± 7 hours per week on household duties or chores.

DATA COLLECTION AND ANALYSIS

One-on-one interviews were conducted with all participants. An inductive descriptive coding process was used to analyze the data after saturation was met. Peer review and researcher triangulation were completed.

RESULTS

Conflict and guilt were discussed as unavoidable given the equally demanding roles of AT and parent. The resulting guilt was bidirectional, as each role is equally important to the AT. The management theme was specifically defined by 3 subthemes: creating a separation between work and parenting roles, the benefits of having a supportive workplace, and the importance of having coworkers and supervisors with shared life experiences.

CONCLUSIONS

The ATs experienced work-family conflict and feelings of guilt from their parental responsibilities. The guilt described by the ATs was bidirectional, as they placed high value on both their parenting and athletic training roles. Guilt was balanced and managed by reducing the spillover from the parental role into work or work into time at home. By separating roles and having supportive workplace environments, including coworkers and supervisors who had similar life experiences, ATs felt they were better able to meet work and home demands.

Athletic Trainers' Use of Support Systems for Balancing Roles as an Athletic Trainer and Parent

CONTEXT

Work-life balance is a topic of interest in the athletic training profession. Particularly for parents, managing work and home roles can be challenging. Social support has been identified as a resource for improving athletic trainers' balance and quality of life and warrants further investigation.

OBJECTIVE

To explore the sources and perceptions of social support among athletic trainers with children.

DESIGN

Qualitative study.

SETTING

Collegiate and secondary school settings.

PATIENTS OR OTHER PARTICIPANTS

Thirty-two athletic trainers who worked in the collegiate (12) or secondary school (20) setting participated. All individuals (19 females, 13 males) were parents, and they ranged in age from 25 to 72 years, with 2 to 52 years of experience as athletic trainers.

DATA COLLECTION AND ANALYSIS

Participants were recruited from a larger cross-sectional survey. A semistructured interview was developed by the research team and reviewed by a peer expert in the field. Respondents completed the interview protocol, which contained questions in numerous areas related to work-life balance. Data analyses were guided by the research questions related to social support and used a phenomenologic approach. We researchers immersed ourselves in the data and engaged in a coding process. Researcher triangulation and peer review were used to establish credibility.

RESULTS

Our participants found social support in their work and home lives. Support was described by source (eg, supervisors, coworkers, spouses, family, friends) and type (eg, emotional, tangible, network). Respondents perceived that support stemmed from understanding, flexibility, sharing responsibilities, and shared life experiences, which aided them in balancing their roles.

CONCLUSIONS

Athletic trainers valued social support and used different types of support to help create work-life balance. Support in the workplace, at home, and from the profession is necessary for athletic trainers who are parents, as it provides a means to help balance roles and responsibilities.

Collegiate Athletic Trainers' Experiences With Work-Family Conflict and Work-Family Guilt Based Upon Organizational Factors

CONTEXT

The collegiate athletic setting has been described as having high workloads and working demands. The extensive time commitment required of athletic trainers working in this setting has been identified as a precursor to work-family conflict (WFC) and work-family guilt (WFG). Although individualized, experiences in the work-life interface can largely be affected by organizational factors (ie, elements specific to the workplace). Staff size and patient load may influence the athletic trainer's feelings of WFC and WFG, yet these factors have not been directly studied.

OBJECTIVE

To examine organizational factors and experiences of WFC and WFG among collegiate athletic trainers.

DESIGN

Cross-sectional study.

SETTING

Collegiate setting.

PATIENTS OR OTHER PARTICIPANT(S)

A total of 615 (females = 391, gender variant or nonconforming = 1, males = 222, preferred not to answer = 1) athletic trainers responded to an online survey. The average age of participants was 33 ± 9 years, and they were Board of Certification certified for 10 ± 8 years. A total of 352 participants (57.2%) worked in National Collegiate Athletic Association Division I, 99 in Division II (16.1%), and 164 in Division III (26.7%).

MAIN OUTCOME MEASURE(S)

Participants responded to demographic and workplace characteristic questions (organizational infrastructure, staff size, and number of varsity-level athletic teams). They completed WFC and WFG scales that have been previously validated and used in the athletic trainer population.

RESULTS

Work-family conflict and WFG were universally experienced among our participants, with WFC scores predicting WFG scores. Participants reported more time-based conflict than strain- or behavior-based conflict. No differences in WFC and WFG scores were found among organizational infrastructures. Weak positive correlations were present between staff size and WFC scores and WFG scores. The number of athletic teams was not associated with WFC or WFG scores.

CONCLUSIONS

Organizational factors are an important component of the work-life interface. From an organizational perspective, focusing on improving work-life balance for the athletic trainer can help mitigate experiences with WFC and WFG.

Perceived Stress as an Indicator of Work–Family Conflict and Burnout Among Secondary School Athletic Trainers

Burnout and work–family conflict (WFC) are stressors faced by secondary school athletic trainers, however, the concept of perceived stress and its relationship to burnout or WFC is not well understood. The purpose of this study was to investigate perceived stress’ relationship with burnout and WFC. Participants reported a WFC score of 40.36 (±15.63), low burnout (40.1 ± 16.28), and moderate stress (15.99 ± 7.02). Perceived stress predicted WFC, but not burnout (b = 1.13, t572 = 14.132, p ≤ .001). One’s level of perceived stress impacts WFC, which indicates higher stress will equal greater work–family conflict.

Work-Family Conflict of Collegiate and Secondary School Athletic Trainers Who Are Parents

CONTEXT

The work-life interface has been a much discussed and researched area within athletic training. The National Athletic Trainers' Association position statement on work-life balance highlighted the profession's interest in this topic. However, gaps in the literature remain and include the roles of time-based conflict and social support.

OBJECTIVE

To compare work-family conflict (WFC) and social support among athletic trainers (ATs) employed in the 2 most common practice settings.

DESIGN

Cross-sectional observational survey.

SETTING

Collegiate and secondary school settings.

PATIENTS OR OTHER PARTICIPANTS

A total of 474 (females = 231, males = 243) ATs who were employed in the collegiate (205, 43.2%) or secondary school (269, 56.8%) setting.

MAIN OUTCOME MEASURE(S)

Data were collected through a Web-based survey designed to measure conflict and social support. Likert responses were summed. Demographic information was analyzed for frequency and distribution. Independent t tests and Mann-Whitney U tests were calculated to determine group differences. Linear regression was used to determine if social support predicted WFC.

RESULTS

Social provisions and WFC were negatively correlated, and the social provisions score predicted WFC. No WFC differences (P = .778) were found between collegiate and high school ATs even though collegiate ATs worked more hours (63 ± 11) during their busiest seasons compared with those in the high school setting (54 ± 13, P < .001). Similarly, no difference (P = .969) was present between men and women, although men worked more hours. Our participants scored highest on time-based WFC items.

CONCLUSIONS

Work-family conflict was experienced globally in 2 of the most common athletic training settings and between sexes. This indicates WFC is universally experienced and therefore needs to be addressed, specifically with a focus on time-based conflict. In addition to time-management strategies, ATs need support from coworkers, peers, and family members.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models

CONTEXT

 Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models.

OBJECTIVE

 To investigate the perceived benefits of and barriers in the medical and academic models.

DESIGN

 Qualitative study.

SETTING

 National Collegiate Athletic Association Divisions I, II, and III.

PATIENTS OR OTHER PARTICIPANTS

 A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models.

DATA COLLECTION AND ANALYSIS

 We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility.

RESULTS

 In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative).

CONCLUSIONS

 The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part I: Quality-of-Life Comparisons and Commonalities Among the Models

CONTEXT

 Some anecdotal evidence has suggested that organizational infrastructure may affect the quality of life of athletic trainers (ATs).

OBJECTIVE

 To compare ATs' perspectives on work-life balance, role strain, job satisfaction, and retention in collegiate practice settings within the various models.

DESIGN

 Cross-sectional and qualitative study.

SETTING

 National Collegiate Athletic Association Divisions I, II, and III.

PATIENTS OR OTHER PARTICIPANTS

 Fifty-nine ATs from 3 models (athletics = 25, medical = 20, academic = 14) completed phase I. A total of 24 ATs (15 men, 9 women), 8 from each model, also completed phase II.

DATA COLLECTION AND ANALYSIS

 Participants completed a Web-based survey for phase I and were interviewed via telephone for phase II. Quantitative data were analyzed using statistical software. Likert-scale answers (1 = strongly disagree, 5 = strongly agree) to the survey questions were analyzed using the Kruskal-Wallis, Mann-Whitney U, and Cohen f tests. Qualitative data were evaluated using a general inductive approach. Multiple-analyst triangulation and peer review were conducted to satisfy data credibility.

RESULTS

 Commonalities were communication, social support, and time management and effective work-life balance strategies. Quantitative data revealed that ATs employed in the athletics model worked more hours (69.6 ± 11.8 hours) than those employed in the medical (57.6 ± 10.2 hours; P = .001) or academic (59.5 ± 9.5 hours; P = .02) model, were less satisfied with their pay (2.68 ± 1.1; χ² = 7.757, P = .02; f = 0.394), believed that they had less support from their administrators (3.12 ± 1.1; χ² = 9.512, P = .009; f = 0.443), and had fewer plans to remain in their current positions (3.20 ± 1.2; χ² = 7.134, P = .03; f = 0.374). Athletic trainers employed in the academic model believed that they had less support from coworkers (3.71 ± 0.90; χ² = 6.825, P = .03; f = 0.365) and immediate supervisors (3.43 ± 0.90; χ² = 6.006, P = .050; f = 0.340). No differences in role conflict were found among the models.

CONCLUSIONS

 Organizational infrastructure may play a role in mediating various sources of conflict, but regardless of facilitators, ATs need to be effective communicators, have support networks in place, and possess time-management skills.