Participants

A total of 28 ATs, 15 women and 13 men, participated in the study. At the time of data collection, 19 ATs were employed at the Division I Football Bowl Subdivision level and 9 at the Division I Football Championship level. The ATs had been certified by the Board of Certification for 12 ± 8 years, and their age was 35 ± 9 years. Of the 28 ATs, 7 were head ATs (HATs) and 21 were assistant ATs (AATs). The average work week for the participants was 64 ± 16 hours during the in-season and 45 ± 11 hours during the off-season. Table 1 provides demographic information for the ATs, who represented 16 National Collegiate Athletic Association universities and National Athletic Trainers' Association (NATA) Districts 1, 2, 3, 4, 9, and 10.

Table 1 Demographic Data

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Procedures

The study used online, asynchronous, in-depth interviewing through Husky CT (University of Connecticut, Storrs, CT), a Web-based management system. Online data collection is growing in popularity, particularly in-depth interviewing, as the method circumvents many of the difficulties presented by in-person interviewing, such as time, cost, and access to research participants.25–32 Follow-up phone interviews were also used to validate findings of the study and to allow participants to clarify or expand upon their initial thoughts and responses to the questions. After gaining approval from the University's institutional review board, we purposefully selected participants for interviewing.27,28 At the outset of the study, we identified inclusion criteria for participation (criterion sampling),29 which included Board of Certification certification, employment within the Division I collegiate setting as a full-time staff member (HAT or AAT), and a minimum of 3 years of full-time experience. Initially, we contacted individuals with whom we were acquainted for study participation (convenience sampling)26,33 and then asked those participants for access to additional participants (snowball sampling).17,26,28,33 Recruitment of participants ceased once data saturation occurred and maximum-variation sampling was achieved.28 Maximum-variation sampling ensured that we involved both sexes, both single and married participants, and those with and without children. We also involved ATs covering different sports and having different levels of responsibility (ie, HATs, AATs). This sampling procedure was chosen instead of a homogeneous sampling to gain a more global perspective of the work and life balance paradigm in collegiate athletics.25,26,28 All participants were recruited via an e-mail, which included a description of the study, methods, and steps for participation. Consent was conceded by enrollment in the study.

After acknowledging interest in the study and completing the background (13-item) questionnaire to provide basic demographic information (eg, age, marital status, family status, years in the profession, number of hours worked in a week, travel schedule, and current sport assignment or position), each participant was e-mailed a log-in name and password for interview completion. Participants completed a series of 3 questions each week for 4 weeks (12 total questions). When they logged on, they had access to only the set of questions posted for that week, but they had the freedom to respond to the 3 questions at any time during the week; this allowed them to reflect upon the questions before answering. Questions were derived from the previous WFC literature1–5,7 and were open ended (see Appendix 1 for the interview guide). To decrease the chance of misinterpretation or miscommunication of the material presented in the interview questions, a common concern with online interviewing,30 we called on a panel of experts (n  =  5) to review the interview guide for content and clarity. The panel included 2 athletic training educators, a qualitative researcher with 15 years of experience, and 2 ATs employed at the Division I level. Feedback from the panel was synthesized, and several minor changes were made to the text to increase the clarity of the questions before data collection.

Once data collection was initiated, participants received a weekly e-mail notification. Those who failed to respond to a posting were e-mailed a reminder. The rationale behind this time frame and data-collection method was to provide participants with demanding schedules the time and opportunity to express their opinions.31 Once the participants completed the online portion, we contacted them by telephone to clarify findings, gain more in-depth information regarding their work environment, and substantiate the initial findings of the online portion of the study. Appendix 2 displays the follow-up interview questions. This step was added to ensure that those participants who were less fluent writers than speakers had the opportunity to accurately articulate their thoughts.30 All follow-up interviews were transcribed verbatim, and all textual data were placed into a word-processing document for analysis.

Data Analysis

The interview transcripts were analyzed using an inductive content analysis34,35 by one researcher with previous experience in qualitative analysis. The analysis was performed by coding textual data with a conceptual label to capture its meaning. The coded concepts were then organized into lower-order themes (thematization).28 As data analysis progressed, all themes and data were reevaluated and reorganized as necessary and, consistent with inductive content analysis35,36 and other studies37,38 using this method, the lower-order themes were grouped together to derive the higher-order themes. The process continued until 3 levels of themes emerged. Once data analysis was complete, the researcher shared the findings and transcripts with a second researcher who had previous inductive content analysis experience to validate the findings (the study's peer debriefer). The analysis process is consistent with basic, or generic, qualitative research studies by Wiersma and Sherman35 and other qualitative researchers.29,36

Trustworthiness was established by member checking, peer review, and data triangulation.26,28,35 After transcription of the follow-up interviews, the researchers shared the transcripts with all the participants as a form of member checking for clarity and accuracy. Additionally, the findings were shared with 5 participants so that we could be certain the emergent categories were viable and credible based on their personal experiences. The 5 participants were randomly selected and all agreed with the study's findings. Interview transcripts, coding sheets, and theme interpretations were shared with the peer debriefer, who had previous qualitative research experience. The peer, an athletic training educator with more than 15 years of research experience and a strong background in qualitative methods, ensured methodologic rigor. Data triangulation was established by interviewing ATs with years of athletic training experience who were employed in various positions (HAT, AAT) and at various levels within Division I (Football Bowl Subdivision level, Football Championship level) and by using both electronic- and telephone-interviewing techniques.

Results

Three higher-order themes emerged from the data analysis: (1) antecedents to work–life conflict (Figure 1), (2) professional factors, and (3) personal factors. The themes of professional and personal factors characterize promotion of a balanced lifestyle. The overall dynamic, as perceived by this sample group of ATs, within Division I athletics regarding effective strategies to balance career and life demands is illustrated in Figure 2. Frequencies and percentages for the themes generated during data analysis are shown in Table 2. Each theme is presented below with supporting quotes. In all instances, pseudonyms are used to maintain confidentiality.

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Table 2 Frequencies of Responses by Themes for Achieving Balance

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Antecedents of Work-Life Conflict

The higher-order (third-order) theme, antecedents of work–life conflict, reveals aspects of the Division I athletic training role that lead to perceptions of conflict. The third-order theme was derived from 3 second-order themes: demands of the profession, control and flexibility of work schedules, and staffing patterns. All participants, regardless of age, years of experience, or marital and family status, experienced challenges during their careers regarding WFC, noting that their personal experiences may have differed in description, but their stories were comparable. The aforementioned themes capture their reflections regarding their experiences.

Professional Factors

The higher-order theme of professional factors is characterized as those strategies that can be applied to the workplace by either the organization or individuals. The professional-factors theme was derived from 2 second-order themes: (1) organizational policies and (2) individual strategies. Supportive working environment and staffing patterns were first-order themes, which typified the organizational-policies category. The second-order theme of individual strategies was derived from several first-order themes: (1) boundaries, (2) prioritization, (3) integration, and (4) teamwork.

Personal Factors

Personal factors were operationalized as strategies or circumstances used by the AT outside of the workplace. This higher-order theme consisted of 2 lower-order themes: (1) supportive family network and (2) work–life separation. Frequently, the ATs discussed and stressed the importance of their personal social networks, which included non-AT friends, spouses, peers, and family members (eg, parents, siblings, husband, children). Jackson stated, “My wife understands what I do and knows how my schedule (or lack of a consistent one) varies. The short version is my family accepts what I do for my career.” Jen echoed this sentiment: “I am fortunate to have a very understanding husband.” Harrietta acknowledged the encouragement she received from her family, which allowed her to manage her responsibilities more effectively:

My family helps me maintain my life balance. They understand the importance of my job and the amount of time that… job takes. All in all, my family never makes me feel guilty about my life balance (or lack of balance).

Kara talked about her family's understanding with regard to scheduling of events and family gatherings:

My family has learned to schedule around the football season, since I don't get a day off from August to December. This helps with the work–life balance so that I don't miss as many family gatherings.

A balanced lifestyle was very important to all participants, and many were able to achieve that balance more effectively through the support of their social networks.

Another frequent comment made by the ATs addressed separating their professional and personal lives. Jake bluntly stated, “Leave work at work.” Taber's comments were consistent with this recommendation. He noted that the most important element in finding a balance was to “leave all of the issues and problems from work at work.” Milly reflected upon her struggles with finding a balance and openly confessed not wanting her work to consume her. She found balance by

not bringing work home [with me]. At the end of the day, if there is an individual injured, an exercise I need to make, or an evaluation I need to do better, I wait until the next day, when I am at work to do these things.

Making a clear distinction between work and personal life can help some ATs reduce the stress and challenges associated with this balance.

Sources of WFC

We identified several antecedents of WFC, including demands of the profession, control and flexibility of work, and staffing patterns. These findings corroborate those of previous researchers1,2 who characterized organizational factors such as work hours, travel, and work schedules as major catalysts to WFC that are reported to have a negative influence on quality of life in this population.17

Although WFC has been proposed to arise because of myriad factors,13 for ATs in this study, the catalysts were grounded in the organizational structure of the workplace. This is not surprising, because athletic training is often characterized as a “time-intensive occupation,”40,41 a description linked to higher reported levels of WFC.1,7,42–44 Long work hours and travel are not unique to the athletic training profession; however, the lack of control over work schedules, coaches' demands and expectations, and inadequate staffing patterns are distinctive to the profession. Lack of control over work schedules and inadequate staffing patterns have been associated with WFC within the Division I clinical settings in the past.1,2 These particular issues have not been associated with WFC in other professions, perhaps because of popular strategies such as flexible work schedules, flex time, and job sharing5,12,14,45,46; when these strategies are used appropriately, scheduling and staffing concerns no longer contribute to WFC.

Another factor that directly influenced control over work schedules was the role of the coaching staff. Understandably, last-minute changes regarding work schedules can affect an individual's ability to manage his or her personal life, and an AT is no exception. Again, organizational culture and work scheduling has been heavily associated with WFC,12,13 and those employees who have control, or the perception of control, over their work schedules report less WFC than those who do not.15

Balancing Work and Family: Professional Strategies

For participants in this study, 2 distinct avenues were available for achieving balance: organizational policies and individual workplace strategies. Many of the anecdotal suggestions within the athletic training literature were comparable with our findings.18–20 On an individual level within the workplace, the need to establish boundaries with coaches and athletes was necessary for many of the ATs to maintain work–life balance. The reality is an AT employed at the interscholastic level will never enjoy a typical workday schedule; however, once the workday is complete, the focus should be on personal interests or domestic care obligations and not additional work responsibilities, which can often wait until the next day. Many strategies to establish boundaries in the workplace exist, but as documented in the aforementioned results and in editorials by Scriber and Alderman19 and Mensch and Wham,20 the use of the word no is a highly effective method. Being a team player, which is another key to successful fulfillment of work–life balance, does not always mean that an AT has to say yes to every additional responsibility or last-minute schedule change. Joe Robinson, a life-balancing expert, encourages the use of the word no to establish work and life boundaries and guarantees its success.47

Almost as important as establishing workplace boundaries is setting priorities. Setting priorities, defined by this group of ATs as setting aside time during the day for non–work-related activities such as exercising, going to lunch with a friend, or doing laundry, have been recommended by several experts in life balancing47,48 and addressed by several keynote speakers at the NATA Annual Meeting and Clinical Symposia.48,49 Instituting priorities can empower individuals, providing them with more control over their personal and professional responsibilities and schedules. Such control is key to fulfillment of work–life balance,15 which is associated with a more productive, committed worker, reduced attrition in the workplace, and bolstered teamwork among staff members.10,45

Teamwork was especially important for this group of ATs in sustaining a balanced life. Regardless of marital or family status, ATs were able to have a sense of balance because of the teamwork culture. On many occasions, ATs were able to attend a child's recital, personal doctor's appointment, or wedding because a fellow AT was able to cover. A strong support system that includes coworkers has been mentioned previously as necessary to promoting life balance in athletic training, particularly for female ATs.22 Furthermore, HATs and administrators should encourage teamwork among staff members because it provides a sense of organizational support, a critical link to improving work and life balance.11,16,42,45

The theory of integration, which has been suggested as a tactic promoting work–family balance,18,50 was also reported by several of the married ATs as an effective way to address last-minute changes or child-care emergencies and even as a way to increase the amount of time spent with family. When appropriate, the ability to include family in the workplace environment can ease the stresses related to WFC. Integration may also be of value for other ATs, regardless of their marital or family status. As with prioritizing personal time regardless of the time of day, using integration to offset lulls or changes in schedules can help an AT achieve a balance. For example, an AT may choose to go for a run, do laundry, or have lunch with a friend during “working” hours when he or she does not have taping duties to complete, rehabilitation programs to oversee, or practice to cover. Although at work, the AT is choosing to use this period of time for personal activities and, as noted earlier, setting priorities can help an individual to find a sense of balance. A direct correlation existed between an increase in “me” time and achievement of balance.19 Similarly, in a recent study44 of professional role commitment, ATs identified time for rejuvenation as a critical aspect of maintaining their commitment over an extended period of time. A period of rejuvenation not only was time away from the day-to-day role of the AT but also provided time to address personal needs.

Personal Strategies

Finding a balance between their personal and professional lives is unquestionably essential for the ATs in this study, and the basis for achievement is a personal support network (Table 2). Relying on family, friends, and coworkers has been cited as a key component in fulfilling work and life balance.22,50 Similarly, in an editorial addressing the personal and professional satisfaction of ATs, family support was highlighted as instrumental in attaining a balanced lifestyle.21 On an individual basis, support was defined in a variety of ways, but it was typically described as the understanding and flexibility of friends and family regarding the nature of the AT's professional demands and responsibilities. Many of the statements made by the participants in this study echoed those of Kaiser,21 who emphasized the need for time away from the workplace and the need for ATs to surround themselves with those who can empathize with the unique job responsibilities of an AT. Our findings relate to previous research44 in ATs that underscored the role of networks to obtain social support and succeed in one's work role.

We are not suggesting that an AT's spouse's career is less important than the AT's career, but it seemed necessary for many of the married ATs to have a spouse with a more flexible work schedule to accommodate the working demands of the AT. Future researchers may investigate the influence of a spouse's career on work–life balance as well as the overall life satisfaction of the AT. Just as a supportive organizational culture affords an employee the ability to attend to family and personal responsibilities, a supportive family network allows the AT to adapt and handle the long work hours and lack of control over work schedules. As scholars continue to investigate effective policies for fulfillment of work–life balance, the influence of supportive family networks outside the workplace should also be studied because of the current paucity of literature on the topic.

The theory of separation, although becoming less popular in the literature,50 appears to provide ATs with an effective strategy in reducing the influence of work on their personal lives. At the core, the theory of separation views work and life as distinct, independent spheres between which individuals attempt to create a distinct division.50 Separation, an unfavorable term for many work–life scholars,43,48,50 suggests that work is not part of life; however, for this group of working professionals, it appeared to provide the necessary relief from the pressures and stresses placed upon them in the workplace. Furthermore, the mindset of separation may allow ATs to increase both career and personal-life satisfaction by not allowing them to negatively influence one another. Several of the ATs attributed their sense of balance to time spent with family or on leisure activities and focusing all their energy while at home with their families, rather than on work issues or responsibilities, a strategy also discussed by Kaiser.21 The theory of separation for this group of ATs may be defined more loosely: that working individuals should concentrate their energies on a specific aspect of their lives (eg, working or spending time with family) instead of trying to multitask or allowing responsibilities to spill over from one realm into the other. Furthermore, the emphasis should be on the quality of work or task completion, rather than on the time spent performing the specific activity. Ultimately, a balanced lifestyle is in the eye of the beholder (balance is defined differently by each person), and the hope is that once a balance is achieved, contentment or personal satisfaction follows.

Limitations

The strategies and policies resulting from this study may not be transferable to all clinical settings because they come from a small (although random) sample. Additionally, the suggestions and thoughts of the participants in this current study may not reflect those of all ATs practicing clinically, but these personal experiences form a foundation for understanding successful practices used to reduce the occurrence of WFC and to achieve work–life balance. This was an exploratory study used to investigate a more global picture within the Division I setting; therefore, future inquiries should be more focused on specific samples (with respect to sex or marital status, for example) within this setting.

Implications

Intuitively, every working professional at some juncture in his or her life struggles with finding a balance, but given the unique job responsibilities of an AT, the struggles are likely to be exacerbated or prolonged. Fortunately, this group of ATs demonstrated that with hard work, communication, and support, attaining a balance is possible within the Division I clinical settings. Although WFC is prevalent in athletic training, as evident by our reported results and previous AT literature,1–3,17 and will continue to occur, several organizational policies and personal strategies can be implemented to help reduce conflicts that may arise. When integrated, the strategies can help the AT to achieve a balance between professional and personal lives. We encourage ATs to strongly consider the strategies presented in this manuscript and recommend selecting life-balancing techniques that meet the individual AT's professional and personal goals and needs. Furthermore, the results generated can assist the AT individually, the sports medicine department collectively, and the NATA globally. At any stage of their careers, ATs can learn to set boundaries and understand at times it is acceptable to “just say no,” especially if their personal satisfaction or family time may be affected. Also, ATs should remember to take time for themselves by being involved with outside interests; doing so will help to promote a sense of balance and encourage a more positive outlook on life. Teamwork among coworkers should be supported at all levels, including by the individual, HATs, and administrators. This strategy by far, along with having a strong support network, was most important in giving ATs the ability to manage their career demands and personal responsibilities. Athletic administrators and HATs should also explore possibilities to allow ATs to have more control over their schedules. Flexible working schedules and control over one's work schedule are effective strategies to help employees meet their responsibilities both at work and at home.4,5 Flexible work schedules in the athletic training environment may be more structured (eg, choosing a particular time of day to accomplish tasks, rather than working from home) than in other working environments but can still allow the AT to accomplish nonwork tasks on certain days.

In its strategic plan,51 the NATA indicated the need for an increase in members' personal and professional satisfaction. To move one step closer, the NATA needs to investigate ways to enforce the recommendations of the Task Force to Establish Appropriate Medical Coverage for Intercollegiate Athletics52 regarding appropriate medical coverage for intercollegiate athletics. Falling short of the recommendations, as many departments do, is often the impetus for WFC within this population. Moreover, the NATA should encourage and support teamwork and job sharing (interchangeability of staffing) within sports medicine departments. Inevitably, these accommodations will be the most important elements in helping ATs to achieve a balanced lifestyle, particular in the current economic climate. Job sharing or interchangeability of staff members simply means that each member of the sports medicine staff is qualified to provide medical care for an athlete, regardless of his or her specific sport assignment, and can do so when necessary. Future research, particularly focusing on the influence of staffing shortages, family-friendly working environments, and organizational support on WFC within athletic training, is necessary. Furthermore, although we studied a stratified sample of participants, future authors should study a more homogeneous sample to characterize demographic categories such as single ATs, women versus men ATs, married ATs, and married ATs with children.