Secondary School Athletic Trainers' Experiences Managing Workplace Organizational- Professional Conflict.

CONTEXT: Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must be mitigated, yet little research has determined how ATs manage conflicts with stakeholders. OBJECTIVE: To explore ATs' experiences with OPC in the secondary school setting. DESIGN: Qualitative study. SETTING: Telephone interviews. PATIENTS OR OTHER PARTICIPANTS: 16 ATs (9 females, 7 males; age = 43±11 years; years certified = 17±9; years in their current positions = 9±6). DATA COLLECTION AND ANALYSIS: We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts, and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach. RESULTS: Four themes emerged: effective communication, professional relationships, stakeholder education and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. OPC was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines post-injury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC. CONCLUSIONS: Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.

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.

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 healthcare providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance. OBJECTIVE: Examine the relationship between work-family conflict (WFC), family role performance (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: 586 collegiate athletic trainers (females=374, males=210, gender variant/non-conforming=1, preferred not to answer=1). MAIN OUTCOME MEASURE(S): Data were collected through an online survey (Qualtrics) where participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptives 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 statistically different differences between men and women for WFC scores (U=344667, p=.021). Family role performance was moderately negatively correlated with WFC total score (rs[584] = -.497, p<.001) and predicted WFC scores (b=72.02, t582=-13.30, p=.001). Mann Whitney-U test demonstrated married athletic trainers (47.20±11.92) had statistically significantly higher WFC scores (U=19847.00, p=.003) than those who were not married (43.48±11.78). Mann Whitney U analysis (U=32096.00 p=.001) also found a significant difference between college athletic trainers with children (48.16±12.44) and those without children (44.68±10.90). CONCLUSIONS: Collegiate athletic trainers experience more WFC with marriage and having children. These findings indicate that time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to engage in their family roles, when this is limited WFC increases.

Living well (or not) with patellofemoral pain: A qualitative study.

OBJECTIVE: Patellofemoral pain (PFP) is a common musculoskeletal condition, which has a negative effect on physical activity and function. Currently, it is unknown how and why individuals with PFP modify their physical activity. The purpose of this qualitative study was to explore the experience of knee pain on physical activity and everyday life in individuals experiencing PFP. DESIGN: Qualitative phenomenological interview study. SETTING: University. PARTICIPANTS: Sixteen patients experiencing PFP. MAIN OUTCOME MEASURES: Semi-structured interviews were used to explore the pain experience on physical activity and daily living. RESULTS: Patients with PFP attempted various strategies to remain physically active, such as identifying pain thresholds, activity modification, and pushing through their pain. Despite these various strategies to stay active, pain influenced their social life and patients demonstrated both fear avoidance beliefs and pain catastrophizing. Patients with PFP also reported barriers to seek care for their knee pain, such as negative past experiences with health care professionals and care not aligned with the best evidence available. CONCLUSION: Clinicians treating PFP should be aware of biologic, psychological, and social aspects when evaluating and intervening with patients.

Secondary School Athletic Trainers' Experiences With Organizational Conflict: A Comparison Across Employment Models.

CONTEXT: Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood. OBJECTIVE: To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics. DESIGN: Cross-sectional study. SETTING: Secondary school athletics. PATIENTS OR OTHER PARTICIPANTS: Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8). MAIN OUTCOME MEASURES: Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynamic. Employment type (school district employee, school district teacher, medical or university facility, independent contractor) and status (full time, part time) served as independent variables. Likert-scale scores (1 = strongly agree to 5 = strongly disagree; 1 = always to 5 = never) and perceived sources of stress, pressure, and conflict were the dependent variables. Analyses consisted of Kruskal-Wallis tests with Mann-Whitney U post hoc tests and odds ratios to assess associations between variables of interest. RESULTS: We obtained a 15.3% response rate (725/4745). Although the ATs reported experiencing conflict and pressure, these experiences were relatively infrequent and not universal. Compared with part-time ATs, full-time ATs described higher ratings of strong relationships with coaches (P = .003) and principals (P = .002). The most frequently identified sources of conflict were parents (59%) and coaches (53.9%), followed by athletes (32.6%). Full-time ATs were 1.6 times more likely to report experiencing conflict with a coach than part-time ATs (odds ratio = 1.550, 95% CI = 1.037, 2.317; P = .040). CONCLUSIONS: Secondary school ATs' experiences regarding organizational conflict were relatively positive. Instances of pressure and conflict were noted, though relatively infrequently, and these experiences were largely uninfluenced by employment type.

Work-Addiction Risk in Athletic Trainers and Its Relationship to Work-Family Conflict and Burnout.

CONTEXT: Individual factors can affect numerous work-life interface outcomes, including work-family conflict and burnout. Recently, the concept of work addiction has been investigated as an individual factor that could affect numerous outcomes. Despite the large body of literature investigating work-family conflict and burnout in athletic training, little is known about the incidence of work addiction or its potential effect on these outcomes. OBJECTIVE: To gather descriptive data on the work-addiction risk and examine the effect work addiction may have on work-life interface outcomes in athletic training. DESIGN: Cross-sectional study. SETTING: Online web-based survey. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs) employed in all work settings were recruited to participate via social media and email distribution lists. Data from 226 (n = 65, 28.8% males; n = 161, 71.2% females) ATs, currently employed in more than 13 work settings, were included in data analysis. MAIN OUTCOME MEASURE(S): The online questionnaire consisted of 4 main sections: demographic questions, work-family conflict scale, Copenhagen Burnout Inventory, and the Work Addiction Risk Test. We calculated Mann-Whitney U and Kruskal-Wallis tests to determine if group differences existed. Simple linear regressions were used to assess if work-addiction risk scores predicted burnout and work-family conflict. RESULTS: The ATs experienced moderate levels of personal (55.0 ± 19.1) and work-related (50.0 ± 16.0) burnout and were at medium risk for work addiction (58.3 ± 11.2). No demographic differences were observed in burnout or work-family conflict scores, but these scores differed based on the work-addiction risk. Women were more at risk for compulsive tendencies than were men. Work-addiction risk scores predicted both burnout and work-family conflict, but only a relatively small percentage of the variability was explained. CONCLUSIONS: Those ATs at higher risk for work addiction reported higher levels of burnout. Because of the medium risk for work addiction among ATs, work-addiction mitigation strategies should be implemented by individuals and organizations.

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.

Age, Sex, and Years of Experience: Examining Burnout Among Secondary School Athletic Trainers.

CONTEXT: Burnout is occurring in the athletic training profession. Although data on burnout are growing, the secondary school employment setting is often overlooked in research. With the employment of athletic trainers in the secondary school setting growing rapidly, a better understanding of burnout is warranted, as it has been linked to attrition. OBJECTIVE: To better understand burnout among secondary school athletic trainers using the Copenhagen Burnout Inventory (CBI), with a particular focus on differences between men and women. DESIGN: Cross-sectional survey. SETTING: Secondary school athletic trainers. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers who work in the secondary school setting were recruited via email to participate in the online survey. A total of 572 (373 women, 195 men, and 4 unreported) responses were included after we filtered out incomplete responses. MAIN OUTCOME MEASURE(S): Participants were asked to complete an online survey, which consisted of demographic and workplace questions along with 3 scales (ie, Perceived Stress Scale, CBI, and Work-Family Conflict Scale). Nonparametric analysis was used to investigate the differences in scale scores between groups. RESULTS: Participants reported a mean score of 40.1 (± 16.28) on the CBI scale. Women's scores were higher on the personal burnout subscale (t570 = 24.501, P ≤ .001), work-related burnout subscale (t570 = 11.347, P ≤ .001), and total CBI (t570 = 9.423, P = .002). Participants who were ≤30 years of age scored higher on the personal burnout subscale (t515 = 5.53, P = .019), work-related subscale (t515 = 7.812, P = .005), and total CBI (t515 = 4.194, P = .041). Those with ≤3 years of experience scored higher on the personal burnout subscale (t570 = 11.213, P ≤ .001), work-related burnout subscale (t570 = 6.557, P = .010), and total CBI (t570 = 4.722, P = .030). CONCLUSIONS: Low levels of burnout are being reported among secondary school athletic trainers. Female athletic trainers experienced greater levels of burnout, as well as personal and work-related burnout. Early-career athletic trainers also reported higher levels of burnout, suggesting the need for more support during this time.

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.