Organizational-Professional Conflict in the Collegiate and Secondary School Practice Settings: A Sequential, Mixed-Methods Study

CONTEXT

Athletic trainers (ATs) are employed in various settings, which may use 1 of 3 organizational infrastructure models: (1) the sport/athletic model, (2) the medical model, and (3) the academic model. These different settings and organizational infrastructure models may result in varying levels of organizational-professional conflict (OPC). However, how OPC may differ across infrastructure models and practice settings is not known.

OBJECTIVE

To examine the prevalence of OPC among ATs in various organizational infrastructures and explore ATs' perceptions of OPC, including its precipitating and mitigating factors.

DESIGN

Sequential explanatory mixed-methods study with equal emphasis on quantitative and qualitative components.

SETTING

Collegiate and secondary school institutions.

PATIENTS OR OTHER PARTICIPANTS

Five hundred ninety-four ATs from collegiate and secondary schools.

DATA COLLECTION AND ANALYSIS

We conducted a national cross-sectional survey using a validated scale to assess OPC. We then followed the quantitative survey with individual interviews. Trustworthiness was established with multiple-analyst triangulation and peer debriefing.

RESULTS

Athletic trainers experienced low to moderate degrees of OPC with no differences across practice settings or infrastructure models. Poor communication, others' unfamiliarity with the AT's scope of practice, and lack of medical knowledge were precipitating factors for OPC. Organizational relationships founded on trust and respect for one another; administrative support in that ATs were listened to, decisions were endorsed, and appropriate resources provided; and autonomy given to the AT were key components to preventing OPC.

CONCLUSIONS

Most ATs experienced primarily low to moderate OPC. However, OPC continues to permeate professional practice to some extent in collegiate and secondary school settings, regardless of the infrastructure model used. The findings of this study highlight the role of administrative support that allows for autonomous AT practice as well as effective communication that is direct, open, and professional to decrease OPC.

Perceived Stress, Work–Family Conflict, and Burnout in Irish Certified Athletic Therapists

Burnout and its associated factors are a concern for U.S. athletic trainers, but no research has investigated it from an international perspective. We examined perceived stress, work–family conflict, burnout, coping, and self-care practices in Irish certified athletic therapists. Low burnout (41.0 ± 12.1) and moderate perceived stress levels (17.8 ± 6.2) were observed. Certified athletic therapists with children had significantly higher work–family conflict (p = .02, ) and time-based conflict (p < .001, ) than those without. Moderate resilient coping was noted (14.7 ± 2.5). Low burnout was found, likely due to the use of resilient coping strategies. Time was a limiting factor for both self-care and experiences of work–family conflict.

A Theoretical Model of Transition to Practice for Athletic Trainers

CONTEXT

The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation.

OBJECTIVE

To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs.

DESIGN

Qualitative study.

SETTING

Telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs.

DATA COLLECTION AND ANALYSIS

Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach.

RESULTS

We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies.

CONCLUSIONS

The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

Work-Family Guilt: The Perspective of Secondary School Athletic Trainers With Children

CONTEXT

The literature in athletic training has consistently demonstrated evidence of work-family-life conflict and the potential consequences of that conflict among athletic trainers (ATs) employed in the clinical setting. Parental responsibilities have been suggested to increase the conflict among work, family, and life. The emotions that occur because of this conflict have received little attention and warrant further study.

OBJECTIVE

To investigate perceptions and antecedents of work-family guilt (WFG) among secondary school ATs with children.

DESIGN

Phenomenological qualitative study.

SETTING

Secondary schools.

PATIENTS OR OTHER PARTICIPANTS

Twenty (13 women, 7 men) ATs with children (range = 1-3) employed in the secondary school setting. All but 3 were married (n = 17) at the time of the study. Their average age was 37 ± 11 years, and they were certified as ATs for 14 ± 11 years.

DATA COLLECTION AND ANALYSIS

Participants completed one-on-one semistructured phone interviews. Multiple-analyst triangulation and peer review were used to establish data credibility.

RESULTS

General inductive analysis revealed that men and women participants experienced feelings of WFG despite having supportive work environments. The guilt for both sexes stemmed from work interfering with family and an altruistic mindset. Women indicated they felt pressure from their husbands that contributed to feelings of guilt.

CONCLUSIONS

Secondary school ATs experienced WFG. Trying to balance parental and athletic training duties can cause an emotional response, and ATs' giving and caring nature may be a precursor to guilt.

The Role Mentoring Plays in the Transition to Practice of Newly Credentialed Athletic Trainers

CONTEXT

Mentoring has been identified as an important method of supporting newly credentialed athletic trainers (ATs) during their transition to practice. Gaining a better understanding of this relationship could provide valuable insights that may assist employers and professional programs in developing a plan to better facilitate the transition.

OBJECTIVE

To examine which aspects of the mentoring relationship provided the most benefit during transition to practice of newly certified ATs.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 13 ATs who graduated from a professional master's program, were certified from February through July 2016, and obtained employment from July through August of 2016 participated in this study (6 women, 7 men; age = 26 ± 3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

Phone interviews using a semistructured interview guide were conducted at 3, 8, and 12 months of work experience. Data were analyzed using a constant comparative approach. Credibility was established via investigator triangulation, peer debriefing, and member checks.

RESULTS

Participants recognized the mentoring relationship as a foundational aspect of the transition to practice. Mentors should be available by phone, email, or text to answer questions, provide feedback, or discuss ideas. Respondents wanted honest feedback, even when that feedback was constructively critical. Feedback was sought regarding topics such as patient care, communication, and networking. Participants needed reassurance and support from their mentors to help validate and improve their self-confidence.

CONCLUSIONS

Newly credentialed ATs should seek a mentor who will be available to communicate in various ways and will provide regular and constructive feedback. Future researchers should investigate how mentoring relationships influence other aspects of the transition to practice, such as patient care, overall job performance, turnover, and satisfaction.

The Role Mentoring Plays in the Transition to Practice of Newly Credentialed Athletic Trainers

CONTEXT

Mentoring has been identified as an important method to support newly credentialed athletic trainers during their transition to practice. Gaining a better understanding of this relationship could provide valuable insights that may assist employers and professional programs to develop a plan, which could better facilitate the transition.

OBJECTIVE

To examine what aspects of the mentoring relationship provided the most benefit during transition to practice.

DESIGN

Grounded theory.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

13 athletic trainers who graduated from a professional master's program, were certified between February and July of 2016, and obtained employment between July to August 11 of 2016 participated in this study (6 female, 7 male, 26±3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

Phone interviews using a semi-structured interview guide were conducted at 3, 8 and twelve months of work experience. Data were analyzed using a constant comparative approach. Credibility was established through investigator triangulation, peer debriefing, and member checks.

RESULTS

Participants recognized the mentoring relationship as a foundational aspect of the transition to practice. Mentors should be available by phone, email, and/or text and to answer questions, provide feedback and/or discuss ideas. Participants want honest feedback, even when that feedback is constructively critical. Feedback was sought regarding topics such as patient care, communication, and networking. Participants needed reassurance and support from their mentor which helped to validate and improve confidence.

CONCLUSIONS

Newly credentialed athletic trainers should seek a mentor who will be available to communicate in various ways and provide regular and constructive feedback. Future research should investigate how mentoring relationships influence other aspects of the transition such as patient care, overall job performance, turnover, and satisfaction.

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.

Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making

CONTEXT

Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated.

OBJECTIVE

To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting.

DESIGN

Qualitative study.

SETTING

Semistructured one-on-one telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24-48 years]; years certified = 9 ± 8).

DATA COLLECTION AND ANALYSIS

Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness.

RESULTS

Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations.

CONCLUSIONS

External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Challenges Faced by Collegiate Athletic Trainers, Part I: Organizational Conflict and Clinical Decision Making

CONTEXT

Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood.

OBJECTIVE

To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]).

PATIENTS OR OTHER PARTICIPANTS

A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings.

MAIN OUTCOME MEASURE(S)

The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively.

RESULTS

We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure.

CONCLUSIONS

Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.

Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes

CONTEXT

Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations.

OBJECTIVE

To investigate the challenges faced by ATs when treating concussed student-athletes.

DESIGN

Qualitative study.

SETTING

Online questionnaire.

PATIENTS OR OTHER PARTICIPANTS

A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics.

DATA COLLECTION AND ANALYSIS

We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review.

RESULTS

When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations.

CONCLUSIONS

Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

Emergency Action Plans in Secondary Schools: Barriers, Facilitators, and Social Determinants Affecting Implementation

CONTEXT

Secondary schools (SSs) inconsistently adopt emergency action plans (EAPs) for athletics.

OBJECTIVE

To describe the barriers, facilitators, and social determinants influencing EAP adoption in SSs in the United States.

DESIGN

Cross-sectional study.

SETTING

Secondary schools.

PATIENTS OR OTHER PARTICIPANTS

A national sample of athletic trainers (ATs; n = 9642) and athletic directors (ADs; n = 9687) were invited to participate in a Web-based questionnaire. A total of 1273 (13.2%) ATs and 702 (9.2%) ADs responded to the survey.

MAIN OUTCOME MEASURE(S)

The questionnaire addressed self-reported barriers to, facilitators of, and social determinants (eg, locale, funding classification [eg, public or private SS]) of EAP adoption. The responses of ATs and ADs were analyzed separately. Barriers, facilitators, and social determinants were evaluated using descriptive statistics. Contingency (2 × 2) tables were used to calculate the odds ratios (ORs) of adopting an EAP and the presence of each social determinant.

RESULTS

Perceived barriers to implementation were a lack of knowledge about how to implement an EAP and financial limitations. Facilitators were having access to health care personnel, state mandates, and support from a person in an authoritative position. Compared with ATs at rural schools, ATs at suburban schools displayed greater odds of having an EAP (χ² = 5.63, P = .01, OR = 1.63 [95% confidence interval = 1.08, 2.44]). According to the ADs' responses, a larger SS enrollment (≥500) led to greater odds of adopting an EAP (OR = 2.02 [95% confidence interval = 1.41, 2.89]).

CONCLUSIONS

Perceived barriers to EAP adoption suggest that ATs and ADs need to be educated so they can provide additional information on the low cost of EAP adoption. Further, ADs described state mandates as facilitators to improve EAP adoption; therefore, efforts to educate state leaders about the need for mandated policies may be warranted. Certain social determinants (eg, school enrollment) may affect EAP adoption, but not every proposed determinant significantly affected adoption.

Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice

CONTEXT

Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition.

OBJECTIVE

To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review.

RESULTS

Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance.

CONCLUSIONS

Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

Formal and Informal Work-Life Balance Practices of Athletic Trainers in Collegiate and University Settings

Context

Organizational policies for work-life balance exist, but little is known about athletic trainers' (ATs') awareness of and willingness to use them.

Objective

To explore ATs' formal and informal work-life balance policies in the collegiate and university athletic training setting.

Design

Sequential mixed-methods study.

Setting

Web-based survey.

Patients or Other Participants

We sent 4673 e-mails to National Athletic Trainers' Association ATs (full-time employment for at least 1 year, nonacademic appointment); 1221 participants began our survey (access rate = 26.1%), and 783 completed the survey (64.1% completion rate). Demographics were as follows: men = 375 (48.0%) and women = 404 (51.7%); age = 36 ± 10 years; experience = 13 ± 9 years; years at current place of employment = 8 ± 8 years; and participants with children or minor dependents = 262 (33.5%).

Main Outcome Measure(s)

We created a 17-item instrument from an earlier qualitative study. A panel of experts (n = 3; employer, employee, and researcher) completed a content analysis. Variables of interest were confidence (scale = 1–4) and satisfaction (scale = 1–5) with policies. We used Pearson χ2 analyses to compare the effect of undergoing an orientation and the presence or absence of children on the main outcome measures.

Results

A majority of participants had experienced formal orientation through the human resources department (n = 522, 66.8%), the direct supervisor (n = 240, 30.7%), or a colleague (n = 114, 14.6%). However, many had received no orientation (n = 184, 23.6%). Those who had undergone orientation indicated greater confidence in knowing about (P &lt; .001) and greater satisfaction with (P &lt; .001) formal workplace policies and benefits. Those with children stated that they had greater confidence in knowing about (P &lt; .001) and greater satisfaction with (P = .013) formal workplace policies and benefits. Those who had been oriented felt greater confidence in knowing about (P = .009) but no difference in satisfaction with (P = .060) informal workplace policies and benefits. We did not identify differences between those with and those without children regarding their confidence in knowing about (P = .653) or satisfaction with (P = .150) informal workplace policies and benefits.

Conclusions

Athletic trainers in the collegiate and university setting were not confident in their knowledge of formal or informal work-life balance policies.