Experiences With Workplace Bullying Among Athletic Trainers in the Collegiate Setting
Workplace bullying (WPB) is a series of persistent negative interactions that affect a clinician's ability to perform his or her role. Although WPB has been studied in other health professions, to date, no information exists pertaining to WPB in athletic training. To determine the prevalence of WPB in the collegiate setting and examine factors that influence its occurrence. Cross-sectional study. Collegiate setting. There were 723 (329 female, 394 male) athletic trainers (ATs) aged 37.5 ± 10.4 years. We collected data via the validated and reliable online Athletic Training Environment Survey. Descriptive statistics were obtained to determine a bullying score for each AT and examine the prevalence of WPB. Chi-square analyses were performed to examine the differences between (1) sex, (2) academic degree level, (3) employment title, and (4) National Athletic Trainers' Association district. A total of 106 participants (14.7%) had a score of 2 or higher, indicating they were bullied in the athletic training setting. Of those bullied, 47 (44.3%) were women and 59 (55.7%) were men. There was no difference between women and men with respect to having experienced bullying (χ21 = 0.068, P = .794). Moreover, no difference existed in the prevalence of bullying among ATs holding various degrees (χ23 = 6.73, P = .081) or among ATs holding various titles within an organization (χ25 = 3.55, P = .616). More (χ21 = 23.77, P = < .001) perpetrators were male (74.2%, n = 75) than female (25.8%, n = 26); of these, 38.2% (n = 39) were coaches, 17.6% (n = 18) were supervisory ATs, and 8.8% (n = 9) were coworker ATs. Bullying was experienced by both male and female ATs in the collegiate setting, and a higher number of bullies were male. More research is necessary to explore WPB in other work settings.Context:
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Athletic trainers are recognized health care providers who have gained access into a variety of health care settings. As with any occupational setting, the interpersonal relationships created in the workplace environment can influence one's ability to execute his or her professional role. Although interpersonal conflicts in an organization are not uncommon, the number of episodes that are perceived as more harmful has increased.1 A negative workplace environment can involve subtle episodes or even outwardly hostile conflict and aggression. Such acts between coworkers are referred to as lateral violence,2 but when there is a power difference, then workplace bullying (WPB) may be present.3 For example, an individual with a higher academic degree or higher level of authority in an organization (or both) may have a perceived power differential.
Workplace bullying differs from harassment in that “... in the United States harassment must generally be based on a protected category to be actionable...”4(p3) The Equal Employment Opportunity Commission defines harassment as “unwelcome conduct that is based on race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability, or genetic information.”5 Some forms of WPB could reflect the Equal Employment Opportunity Commission definition of harassment, but those occurrences are limited to individuals in the protected classes outlined. As can be seen by the following definition by Maguire and Ryan,6 instances of WPB are often more subtle than harassment and can occur to anyone in an employment setting.
Maguire and Ryan6 explained WPB:
... is a behavior that goes beyond simple rudeness and incivility. While bullying may include overt aggression or threat of violence, like other forms of aggression experienced... it frequently involves subtle or covert acts, rather than direct violence.(p120)
In previous research, victims reported both physical7–9 and mental10–12 health problems, including posttraumatic stress disorder,10,12–15 because of being bullied at work. Bullying has also been linked to decreased productivity, increased absenteeism, and greater attrition.16,17 As a result, WPB is an emergent critical issue facing health care providers in a variety of settings.
Nursing, in particular, has long identified WPB as a prevalent issue.18 More recently, however, other health professions, such as occupational therapy,19–22 physiotherapy,23,24 and indeed medicine,25–28 have also identified WPB as a work-related concern. Common to these publications related to bullying is the idea that the health care environment creates many interpersonal interactions that can raise the level of interpersonal conflict.
The roots of athletic training are in the collegiate athletic environment. As a result, this employment setting has been widely investigated for organizational issues, including burnout,29 professional socialization,30,31 work–family conflict,32–35 and sexual harassment,36–38 but to date, WPB has been neglected. Because athletic trainers (ATs) interact with a myriad of individuals, such as physicians, coaches, and administrators, an investigation of WPB can identify whether it permeates the college AT's setting. Therefore, our overall objective for this research was to examine the prevalence of WPB among ATs working in the collegiate setting and to identify the personnel involved with the bullying acts. We also sought to investigate the influence of sex on the occurrence of WPB. The following research questions guided our study:
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What is the prevalence of WPB among collegiate ATs in the United States?
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What positions do the bullying perpetrators hold in the organizations?
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Do female ATs experience WPB more than male ATs?
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Are male bullies more common than female bullies?
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Does an individual's academic degree, employment title, or geographic location influence the prevalence of bullying?
We initiated the study with the following hypotheses:
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H1: Female ATs experience more WPB than male ATs.
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H2: Male bullies will be more common than female bullies.
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H3: Academic degree, employment title, and geographic location do not influence the prevalence of bullying.
METHODS
A cross-sectional survey design was used to examine ATs' perceptions of WPB. Participants completed an online survey requiring them to provide demographic information and to identify the frequency of possible negative acts experienced during their employment in the collegiate setting. After completing the Negative Acts Questionnaire—Revised (NAQ-R),39 the respondents were provided a definition of WPB and given the opportunity to self-identify as either a witness to or a victim of WPB. This part of the survey allowed them to identify personnel associated with the WPB incidents.
Participants
Participants were recruited from a randomized list of e-mail addresses (3000) created by the National Athletic Trainers' Association Member Services Department. Eligible participants were from the certified category employed in the university and college setting. Eligible participants were sent a recruiting e-mail outlining the purpose of the study, describing the survey, and explaining how informed consent is obtained and provided with the Web site address to the survey. In keeping with the directions for the NAQ-R,39 the terms bullying and harassment were not referenced in the recruiting e-mail; rather, WPB was described without using these terms. The invitation to participate was followed by 2 courtesy reminders sent approximately 3 weeks apart.
Instrumentation
The Web-based survey was administered using Survey Monkey (Portland, OR). The survey consisted of 3 sections: demographic data, NAQ-R, and experiences with WPB. Section 1 consisted of 8 questions on sex, age, education level, years certified, National Athletic Trainers' Association district, and information regarding current position, such as competition level (eg, National Collegiate Athletic Association Division I, II, III) of the college or university, years employed, and leadership structure. The second section was the 22-item NAQ-R, which was used with permission from the Bergen Bullying Institute.39 The generic nature of the NAQ-R provides flexibility in the populations the instrument is used with and therefore required no modification for this study. In the NAQ-R, participants receive examples of negative acts, such as “Someone withholding information which affects your performance”; “Having key areas of responsibility removed or replaced with more trivial or unpleasant tasks”; or “Being ignored or excluded.” Items do not reference the terms bullying or harassment as recommended by Arvey and Cavanaugh.40 Crafting the items in behavioral terms is thought to provide a more objective measurement of exposure to WPB than the self-labeling approach. Participants then indicate the frequency (never, now and then, monthly, weekly, daily) with which they were exposed to the negative acts in the last 6 months. As with previous research in nursing3 using the NAQ-R, a bullying score is calculated by giving 1 point for every item marked weekly or daily. Participants with a score of 2 points or more were considered to have experienced WPB.
In 2009, Einarsen et al41 established the reliability and validity of the NAQ-R. With a Cronbach α of .90, the NAQ-R has excellent internal consistency, and research revealed 3 underlying factors: personal bullying, work-related bullying, and physically intimidating forms of bullying.41 For the current study, the internal consistency of the NAQ-R instrument was .84.
Relating the scores on the NAQ-R to a single-item measure of perceived victimization from bullying helped to establish the criterion validity and resulted in high correlations with both the total NAQ-R and scores on the 3 factors. Victims of WPB scored higher on all 22 items than nontargets.41 Construct validity was also established through the NAQ-R correlating as expected with measures of mental health, psychosocial work environment, and leadership.41
We created the final section of the survey and asked questions regarding the witnessing or experiencing of negative acts in the workplace. Items in this section of the questionnaire related to not only experiencing or witnessing negative acts but also the organizational positions of the victim and the bully. Participants were provided with a definition of WPB, but as in section 2 of the survey, the term workplace bullying was not used. Questions regarding the respondent's experiencing or witnessing negative acts were dichotomous yes/no questions. Based on the answers to those questions, the cascading logic of the survey directed the participant to specific pages. For example, if a participant answered yes to the statement, “In the past 6 months, I have witnessed negative acts in the workplace,” he or she was sent to a page with additional questions about the victim and the bully. A participant who answered no to the same statement continued on to “In the past 6 months, I have experienced negative acts in the workplace.”
Although the NAQ-R is a well-established instrument, the first and third sections of the questionnaire required a review so that we could establish face and content validity. A 3-person panel composed of individuals with research expertise in organizational conflict was convened to examine the survey and provide feedback to address face and content validity. We made minor adjustments to the language after the expert panel review.
Procedures
After receiving institutional review board approval, we sent a recruiting e-mail to 3000 ATs practicing in the collegiate setting. Of the 3000 ATs, 827 responded, for a response rate of 27.6%. Of these, 723 (24.1%) provided complete and usable survey data.
We conducted data analysis using SPSS (version 19.0; SPSS Inc, Chicago, IL).42 Descriptive statistics of the participants' demographic data and for each item on the NAQ-R were calculated. Also, the number and percentage for each NAQ-R item were examined. As in previous research using the NAQ-R,39 we calculated the prevalence of bullying by identifying a bullying score for each participant based on his or her responses to the checklist of negative acts. Descriptive statistics were used to examine the positions the bullying perpetrators held in the organization. A χ2 analysis was conducted to examine whether women experienced more bullying than men, whether the occurrence of a male bully was more likely than a female bully and whether an individual's academic degree, employment title, or geographic location influenced the prevalence of bullying. All analyses had an a priori P value of < .05.
RESULTS
A total of 723 respondents participated in this study: 329 (45.5%) women and 394 (54.5%) men. The mean age of the participants was 37.5 ± 10.4 years, and they averaged 13.7 ± 9.6 years of athletic training experience. The majority (79.1%, n = 572) held a master's degree, 92.4% (n = 669) classified themselves as employed full time, and only 27.9% (n = 202) served in a dual position with academics and athletics. Participants held various titles, including head athletic trainer (40.4%, n = 292), associate athletic trainer (6.6%, n = 48), and assistant athletic trainer (36.7%, n = 265). Certified students holding the positions of graduate assistant (3.2%, n = 23) or intern (1.9%, n = 14) also participated. Several participants (11.2%, n = 81) chose the other category in reference to job title and provided various titles. A sample of these titles can be found in Table 1. The majority (79.3%, n = 573) of individuals who completed the online survey represented National Collegiate Athletic Association Divisions I, II, and III, but the National Association of Intercollegiate Athletics and National Junior College Athletic Association were also represented. Additionally, all National Athletic Trainers' Association Districts were represented, as shown with further demographic information in Table 2.
Prevalence of Bullying
The mean score for the NAQ-R was 0.730 ± 1.84. The frequency of responses to the NAQ-R is presented in Table 3. A total of 106 participants (14.7%) had a score of 2 or higher, indicating they were bullied in the athletic training setting. The χ2 analyses revealed no difference in the prevalence of bullying among ATs holding various degrees (ie, bachelor's, master's, or doctorate; χ23 = 6.73, P = .081) or among ATs holding various titles within an organization (χ25 = 3.55, P = .616). Also, we found no difference when comparing ATs in different districts (χ29 = 11.08, P = .27).
In addition to the frequency of negative acts, participants also self-identified if they had experienced bullying in the last 6 months. A complete delineation of the situations they identified is found in Figure 1. Of the 723 participants completing the survey, 103 (14.4%) experienced bullying; of those, 101 participants described the situation in which the bullying occurred. Of the perpetrators identified, 39.2% (n = 40) were coaches, 17.6% (n = 18) were supervisory athletic trainers, and 8.8% (n = 9) were coworker ATs. Several participants (17.6%, n = 18) identified the bullying perpetrator as in the other category. Upon further review, we broke this category into the following groups: administrators (8.8%, n = 9), academic supervisors (1.94%, n = 2), faculty coworkers (1.94%, n = 2), and general athletic employees (2.12%, n = 5).
Citation: Journal of Athletic Training 49, 5; 10.4085/1062-6050-49.3.16
Participants also had the option of identifying if they had witnessed a bullying situation. Of the 722 participants providing a response, 142 (19.6%) witnessed WPB while performing their duties as an AT in the collegiate setting. Of the 142 bullying witnesses, 30.1% (n = 41) identified a coach bullying an AT. The next largest bullying category was among ATs, with 16.2% (n = 22) occurring between a supervisory AT and a subordinate AT and 6.6% (n = 9) between colleague ATs. A visual representation of the bullying situations as identified by witnesses is provided in Figure 2.
Citation: Journal of Athletic Training 49, 5; 10.4085/1062-6050-49.3.16
Similar to those who experienced bullying, participants witnessing bullying actions had the opportunity to share all such instances by selecting the other category. Upon further analysis of this category, we found that several participants reported witnessing multiple bullying situations. As a result, 50 respondents (36.8%) of the 142 who witnessed bullying identified 67 bullying situations: perpetrators were coaches (38.8%, n = 26), administrators (32.8%, n = 22), faculty (8.96%, n = 6), ATs (8.96%, n = 6), athletes (7.46%, n = 5), parent of an athlete (1.49%, n = 1), and student (1.49%, n = 1). The perpetrators and victims of bullying identified by the participants are displayed in Table 4.
Influence of Sex on Bullying Incidences
Participants in this study were identified as bullied in 2 ways, specifically via their NAQ-R score of 2 or higher, as well as by self-identification. First, 106 individuals were identified as bullied based on their NAQ-R score. Of these, 47 (44.3%) were women and 59 (55.7%) were men. The χ2 analysis revealed no difference between women and men with respect to having experienced bullying (χ21 = 0.068, P = .794). Of the 103 participants who self-identified experiencing bullying, 47.6% (n = 49) were women and 52.4% (n = 54) were men, which reflected no difference (χ21 = 0.221, P = .639). We had hypothesized that female ATs experienced more bullying than male ATs. Based on the analysis, this hypothesis was rejected.
We also hypothesized that male bullies would be more prevalent than female bullies. A 1-way χ2 test revealed a difference between the sex of the perpetrators (χ21 = 23.77, P = .001). The majority of perpetrators (74.2%, n = 75) were male, whereas 25.8% (n = 26) were female. Therefore, we accepted the hypothesis that male bullies were more common than female bullies. An additional χ2 analysis was conducted to examine whether there was a difference between the sex of the perpetrators for male and female victims. We found no difference (χ21 = .026, P = .871), meaning that both female and male victims were bullied by nearly equal numbers of female and male bullies.
A more in-depth analysis of participants who self-identified having experienced bullying revealed that the 49 female victims were bullied by men in 36 cases and women in 12 cases. One participant identified herself as a female experiencing bullying but did not provide further information regarding her experience. The job titles and sexes of the perpetrators responsible for bullying the female victims are shown in Table 5. Moreover, 54 male participants reported experiencing bullying while working as a collegiate AT. In these incidents, 39 of the bullies were men and 14 were women. Similarly, 1 participant identified himself as a man experiencing bullying but did not provide further information regarding his experience. The job titles and sexes of the perpetrators responsible for bullying the male victims are displayed in Table 6.
DISCUSSION
The purpose of our study was to examine the prevalence of WPB among ATs working in the collegiate setting. Workplace bullying is defined as
a behavior that goes beyond simple rudeness and incivility. While bullying may include overt aggression or threat of violence, like other forms of aggression experienced... it frequently involves subtle or covert acts, rather than direct violence.6(p120)
The healing orientation of health care would seem to provide immunity to the harshness of WPB; unfortunately, according to Namie,43 Director of the Workplace Bullying Institute, quite the contrary is true. Namie believes bullying is widespread in the health care arena.44
Prevalence of Bullying
In this study, 103 of 723 participants (14.4%) indicated experiencing bullying, and 142 of 722 (19.6%) indicated witnessing bullying during their last 6 months of employment. These findings are lower than the results of previous research26 on medical students in the United States. Frank et al26 reported that 42% of seniors experienced bullying, and 84% described belittlement during medical school. Similar results were provided by medical students in Pakistan, where 52% reported being bullied.25 The lowest percentage of bullying of medical students was the United Kingdom: 37%.18 Nursing also demonstrated high percentages for experiencing bullying. For example, 44% of nurses self-identified as targets of WPB.45 This is comparable with a study by Guynn,17 who revealed that 38% of employees surveyed experienced 1 or more types of bullying, and 42% witnessed the bullying of others. Additionally, Yildrim46 noted that 86% of nurses faced 1 or more bullying behaviors within the previous 12 months. These high percentages were seen in nonhealth care professions as well. Namie and Namie47 reported that 66% of all respondents experienced or witnessed WPB, and 83% of the bullies were in managerial positions. A more recent study by Bilgel et al48 found that 55% of the participants endured at least 1 type of bullying in the last year, and 47% were witnesses of bullying in their workplace.
The low prevalence of WPB in athletic training may be attributed to an environment in which teamwork and camaraderie are common features of the culture. Worth noting is how this supportive and team-oriented culture is often created by individual employees who emphasize a supportive working environment rather than originating with administration.34 Previous researchers34 have suggested that components of teamwork help ATs balance the demands of their roles.
With regard to experiencing bullying, we found no differences among (1) women and men, (2) ATs holding various degrees, (3) ATs holding various titles, and (4) ATs employed in different districts. These findings are comparable with those of Johnson and Rea,3 who reported no difference in experiencing bullying when compared by sex, age, educational level, level of expertise, sexual orientation, ethnicity, number of years as a nurse, or how long the nurse had been in the current position. Bullying can affect anyone, and it does not discriminate based on sex, age, education, or experience.
Influences of Sex on Bullying Incidences
In our study, the incidence of bullying was similar for women and men. This finding is in contrast to other health professions, in which women were more often bullied than men.18 Our results, however, parallel a 1996 study by Leymann and Gustafsson,14 who noted that men and women were subjected to bullying in near-equal proportions of 45% and 55%, respectively, but conflict with a 2003 study that identified women as 80% of the bullied victims.7 Leymann and Gustafsson14 found that men were more often bullied by men and women were more often bullied by women; Hoel and Cooper49 observed similar results. In 2003, a study sponsored by the Workplace Bullying Institute revealed that women bullied 63% of female victims, and men bullied 62% of male victims.7 Our current data contrast with the previous research in that men were the bullies more often than women, regardless of the sex of the victim. This finding may be because of the continuing male domination of collegiate athletics as compared with other disciplines (eg, nursing) studied by the Workplace Bullying Institute.
Some organizations have implemented WPB policies. For example, in May 2011, the Occupational Safety and Health Administration adopted a WPB policy for its own employees.50 In September 2010, the State of Washington Department of Education enacted a WPB policy for all employees.51 Choice Industrial Training, a company providing training courses in welding, crane, and forklift operations, provides its policy on the company Web site.52 Moreover, organizations and individuals are taking action to make various workplaces more aware of WPB. For example, the Washington State Department of Labor and Industries53 has initiated an educational program to inform employees about the types of behaviors that constitute WPB, how bullying affects the individual and the organization, and what can be done to intervene in a bullying situation. Awareness of WPB is also being enhanced through the use of contemporary social media. Individuals suffering from or wanting to know more about WPB can even friend the “Bullying in the workplace awareness” page on Facebook.54
Limitations
The most significant limitation of our study was the sample size. Although large, it represents only a 24.1% response rate, and therefore the nonresponse bias cannot be fully determined. However, an informal review of other published research reveals that this response rate is normal in athletic training online media. Another limitation is that the sample consisted only of ATs who were members of the National Athletic Trainers' Association. Finally, this study is a 1-time, cross-sectional survey and represents a snapshot in time. A longitudinal study over a period of time would provide a better understanding of the influences and effects of WPB.
Implications and Future Directions
Workplace bullying is beginning to receive attention in a variety of professions, and legislation has been proposed in a number of states.55 Although no state has enacted WPB legislation, the sheer volume of states examining the problem (21) demonstrates how the effects of WPB are beginning to be noticed, and there is no sign of resolution in the near future. At the time of this writing, proponents were petitioning the Ohio State Legislature to pass the Healthy Workplace Bill to protect workers from abuse and bullying in the workplace.56
Given the prevalence of WPB in the health care professions, support for employment policies and legislation (or both) addressing WPB would benefit the athletic training profession as a whole. We recommend addressing WPB in future continuing education workshops to help participants learn to identify and deal with negative acts. Moreover, creating a WPB policy template specific to the athletic training setting, which includes a strongly worded definition and the unacceptability of the behavior, would be a positive step toward addressing the problem.
Future research on WPB in athletic training should focus on other athletic training settings, including high schools, the clinical environment, and nontraditional environments such as industry, the military, law enforcement, and the performing arts. Also of interest is the prevalence of bullying occurring during the educational preparation of ATs. Previous authors25,26,28,57,58 in other health professions have focused on bullying occurring while preparing for the career, and athletic training should follow suit. As other health care professions have previously assessed,3 the athletic training profession should study the connection between WPB and intent to leave the current position, the setting, or the profession altogether.
CONCLUSIONS
Athletic trainers have a unique work setting involving extensive interaction with a variety of populations and personalities. This exposure is often professional and mutually respectful, but as the participants in this study illustrate, the interaction is not always pleasant. As the profession of athletic training continues to advance in competence and respect, our leaders are in a unique position to foster an environment that encourages open communication and collaboration. Although future investigators will continue to provide information on the occurrences and effects of WPB in athletic training, ATs of all ages and in all settings can begin to combat WPB starting today. All ATs can examine their own behaviors and the behaviors of those around them, report any WPB that occurs, and continue to keep the lines of communication open and educate those individuals we interact with daily.
Delineation of experienced bullying situations. Abbreviations: AT, athletic trainer; ATS, athletic training student.
Delineation of witnessed bullying situations. Abbreviations: AT, athletic trainer; Ath, athlete; ATS, athletic training student.
Contributor Notes