Perceptions of Workplace Bullying Among Athletic Trainers in the Collegiate Setting
Bullying has received a vast amount of attention in the recent past. One form of bullying, workplace bullying (WPB), has been a substantial concern explored in many health professions that can negatively influence a health care provider's role in an organization. To date, however, WPB has not been investigated in athletic training contexts. To examine the perceptions of certified athletic trainers who experienced or witnessed WPB during employment in the collegiate setting. Qualitative study. College or university. Fifteen athletic trainers (7 women, 8 men) with an average age of 42 ± 12 years. Data were collected via semistructured, in-depth phone interviews or asynchronous online interviews. Data were analyzed using an inductive content analysis. Trustworthiness was established with member checks and peer debriefing. Four themes emerged from the analysis: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of workplace environment training. The antecedents of WPB involved the bully's personality and perceptions of the athletic training profession as well as environmental factors including the pressure to win and a lack of administrative support. The consequences of WPB included increased stress, feelings of inadequacy, and increased distrust. Individuals coped with WPB by relying on emotional resilience and avoidance. A final theme, lack of workplace environment training, revealed that little attention was given to interpersonal issues and WPB in the workplace. Workplace bullying incidents occur when administrators tolerate bullying behaviors from controlling and manipulative individuals who lack respect for the athletic training professional. Several negative outcomes result from bullying interactions, including stress and anxiety; WPB is dealt with by learning to be more emotionally resilient and avoiding confrontations. Workplace training is needed to prepare athletic trainers for such negative experiences.Context:
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As health care providers in a variety of settings, certified athletic trainers (ATs) must work closely with an array of individuals to provide quality health care. These interpersonal interactions can influence an AT's ability to perform his or her role, especially if conflict arises. Although occasional interpersonal conflicts are not uncommon in a work environment, repeated subtle episodes affecting performance or outwardly hostile acts can create a negative workplace environment due to the presence of workplace bullying (WPB).
Workplace bullying is explained by Maguire and Ryan1 as
… a behavior that goes beyond simple rudeness and incivility. While WPB 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.1(p120)
Another feature of WPB is that an individual repeatedly is the target of negative actions from 1 or several individuals in an organization2 and a power disparity between the bully and the victim exists.3–5 Some examples of WPB include intimidating behaviors, ridicule in connection with an employee's work, withholding information that affects an employee's job, gossiping, being condescending or patronizing, allocating unrealistic workloads, taking credit for others' work without acknowledging their contributions, and blocking career pathways, just to name a few.6
Harassment is commonly defined as “any unwelcome conduct based on a protected class under the federal civil rights laws that is severe, pervasive, or persistent and creates a hostile environment.”7(p6) Both bullying and harassment involve actions that attempt to degrade, intimidate, or victimize an individual, but they are not one and the same—bullying is a relationship issue, whereas harassment is a human rights issue.7(p6) Unfortunately, as Namie8 stated, “Bullying is nearly invisible. It is nonphysical, and nearly always sublethal workplace violence.”(p2) Also contributing to the effect of WPB is that no current laws in the United States protect an individual from WPB, although several states have proposed legislation. In 2010, versions of the Healthy Workplace Bill were introduced but did not pass in New York and in Illinois.9 This was followed by versions of the bill being introduced in California, Connecticut, Hawaii, Kansas, Massachusetts, Maryland, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, Oklahoma, Oregon, Utah, Vermont, Washington, West Virginia, and Wisconsin.10 Although none of these states enacted the bill, the sheer volume of states examining the issue of WPB demonstrates how the effect of WPB is beginning to be noticed.
This increase in attention to WPB may be because of previous research11,12 on WPB illustrating a decrease in productivity, increased absenteeism, and greater attrition. Victims also reported both mental health problems, including posttraumatic stress disorder, anxiety, and depression,4,5,13–15 and physical problems.8,16,17 Previous research in nursing,11–26 occupational therapy,27–30 physiotherapy,31,32 and medicine33–36 illustrates how WPB is an emergent critical concern for a variety of health care providers.
Organizational factors including burnout,37 professional socialization,38,39 work–family conflict,40–43 and sexual harassment44–46 have been widely investigated in athletic training, but to date, WPB is absent from the research. Unlike the other organizational factors, WPB research is still in its infancy. As a result, a greater understanding of prevalence, factors contributing to a WPB-conducive environment, and the effect of WPB on ATs is needed. Therefore, the purpose of our study was to explore ATs' perceptions of WPB in the collegiate setting.
METHODS
Research Design Overview
To gain a more complete picture of WPB in athletic training, we used a mixed-methods approach to complete a large study. Because of the large volume of data, the quantitative results displaying the prevalence of WPB of ATs employed in the collegiate setting are presented elsewhere.47 For this article, we present the personal perceptions component of the study. Those individuals who participated in this portion of the study indicated experiencing or witnessing WPB, agreed to participate in follow-up interviews, and were then randomly selected for participation.
Participants
Individuals indicating a willingness to participate in the interview were randomly selected and contacted. Ultimately, all individuals who indicated they had witnessed or experienced WPB and were willing to participate were contacted by either phone or e-mail. Fifteen individuals completed an informed consent form and had an interview scheduled. Although saturation occurred after 10 interviews, we ultimately conducted all 15 interviews, and of those 15 interviews, 10 were conducted by telephone and 5 were conducted online. The demographic information of the 15 interview participants can be found in the Table. Institutional review board approval was obtained before data collection.
Data-Collection Procedures
Interviews were conducted by phone or in an asynchronous online manner, whichever was more convenient for the interviewee. The 10 telephone interviews used an open-ended, semistructured format, including probing for enhanced clarification, and followed a predetermined order as outlined in Figure 1. This semistructured format allowed the participant to elaborate on his or her experience and provide information regarding its personal effect. The primary author (C.W.) developed the interview questions based on the research questions in an attempt to examine the human perspective of WPB. Therefore, the questions were designed to provide information on the organizational structure at the victim's institution, including the roles of the victim and bully; the professional and personal effects the WPB had on the victim; and previous training or coping strategies used by the victim in response to the WPB. The interview guide was based on the purpose of the study and was reviewed by 3 experts in organizational dynamics and survey research. Based on their review, only slight modification for order of questions and grammar was necessary. The 5 online interviews were not conducted in a live-chat situation, so we used a structured format of pertinent questions and supportive probes. These asynchronous online interviews were securely conducted via Survey Monkey (Portland, OR). Participants were e-mailed a link to the interview guide and could complete the interview at their convenience. Any clarification of the content was done via e-mail.
Citation: Journal of Athletic Training 49, 5; 10.4085/1062-6050-49.3.13
Data Analysis
The lead author (C.W.) performed an inductive content analysis following the guidelines presented by Côté et al8 for all interviews. This system used manual coding for the systematic grouping of information based on content. First, the transcripts were transcribed verbatim and reviewed for the creation of comprehensible items that could stand alone, known as meaning units.48 The meaning units were then further analyzed by creating tags to describe similar information. The tags were assembled into properties based on the features within the tags.48 Finally, the properties were grouped into themes.48 Pseudonyms were used for all identifying characteristics. We established a minimum of 10 interviews but ultimately conducted 15 interviews.
Trustworthiness of Data Analysis
To assure the trustworthiness of the study, a full verbatim transcript for 8 of the 10 phone interviews was returned to participants before coding for verification of accuracy and content. Ideally, all interviewees would have participated in the member-checking process, but 1 participant was experiencing a transition and was unable to complete the transcript review in the allotted time frame. As a result, transcripts were provided to 9 of the 10 telephone interview participants, but 1 transcript was not returned. Using this member-check process allowed us to confirm the accuracy of the content within the interview transcript. To confirm the absence of researcher bias, 2 additional personnel performed peer debriefing once the interviews were concluded to review the findings and confirm the appropriate analysis and interpretation of the data. Debriefing personnel had substantial qualitative research experience and were authors of numerous qualitative research studies published in athletic training periodicals.
RESULTS
Participant Demographics
Demographic information about the interview participants is shown in the Table. Interviewees consisted of 8 men and 7 women with a mean age of 42 ± 12 years. Participants represented 8 of the 10 National Athletic Trainers' Association districts (Districts 8 and 10 were not represented) and were employed at the National Collegiate Athletic Association Divisions I, II, and III; National Association of Intercollegiate Athletics; and National Junior College Athletic Association competitive levels. Interviewees were clinicians, individuals holding dual positions (both faculty and practitioners), and academicians.
Emergent Themes
The inductive analysis, represented in Figure 2, resulted in 4 emergent themes: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of training regarding the workplace environment. Several of these higher-order themes contained lower-order themes. The first theme, antecedents of WPB, included the lower-order themes (1) personnel factors, which included the bully's personality and perceptions of the athletic training profession; and (2) environmental factors, including the pressure to win and a lack of administrative support. The second theme, consequences of WPB, included the lower-order themes (1) increased stress and anxiety, (2) feelings of inadequacy, and (3) increased distrust. In the third theme, individuals identified coping with WPB by relying on the 2 lower-order themes of emotional resilience and avoidance. A final theme, lack of workplace environment training, revealed that little attention was given to interpersonal issues, including harassment, discrimination, and WPB, with regard to the treatment of the AT. In the following section, these higher-order and lower-order themes are explained and supported by participant quotes. Confidentiality is maintained through the use of pseudonyms for all participants.
Citation: Journal of Athletic Training 49, 5; 10.4085/1062-6050-49.3.13
Antecedents of WPB
The first emergent theme, antecedents of WPB, revealed the precursors of WPB as perceived by the participants. These antecedents were further organized into personnel factors and environmental factors. The antecedents in Figure 2 portray the interaction between the personnel and environmental factors in the occurrence of WPB.
Personnel Factors
The personnel factors identified as a precursor to bullying consisted of the personality of the bully and the bully's perceptions of the athletic training profession.
Personnel Factors: Personality of the Bully
Participants described a variety of personality characteristics, such as the bully's being controlling, jealous, retaliatory, insecure, arrogant, or self-centered (or a combination of these). For example, Ryan, in his phone interview, described his bully as controlling by trying to dictate how his athletic training role should be performed:
I think that he… was not interested in being a colleague. He was not interested in working together. He was more interested in being my boss and trying to tell me what to do… all he's really going to bully his way around… he's really going to make it to where he wants to dictate what goes on in all aspects of his world and because athletic training is a part of his domain, then by golly you're going to do what he says or there's going to be some, some issues and problems.
During her phone interview, Tiffany corroborated the controlling personality factor when she explained the behavior of the administrator she viewed as a bully toward her:
When you have someone with no medical knowledge… trying to micromanage a medical individual, it's going to fail… she thinks that she can handle everything… she thinks if she just sends an e-mail out to the other ADs [athletic directors] in our conference to figure out how they do things, then that's the end-all be-all…
Chris' phone interview illustrated how his bully seemed to be jealous of Chris' accomplishments:
My personal feeling is that he is jealous of my successes as an athletic trainer, he is intimidated by my education, my intelligence, so for him what he does he just tries to circumvent it and just put his authority into the whole situation… it's a personal problem on his part, absolutely… he feels like he's not up to everybody, so his answer to that… is to bring everybody down to him.
While completing her phone interview, Susan identified her bullying being caused by previous interactions with the bully: “I think she feels that I've embarrassed her once or twice and this [is] her way of getting even with me. I think it's an abuse of power, she's a boss and she's not a leader.”
During his phone interview, Alex illustrated how insecurity can fuel a bully. He explained:
[I] deal with an individual that tends to blame others for things that they're not responsible for. You know it's… an individual's inability to take responsibly for their own actions, and always wanting to play the role of a victim.
Shawn elaborated in his phone interview into the personality behind some bullies. He articulated, “I think sometimes the worse violators are the insecure coaches trying to prove themselves, trying to be the next Nick Saban [high-profile football coach].”
Finally, Jason's phone interview linked being a bully to the nature of coaching: “…the tendency for coaches to deal with things in a bullying manner to feel like they're being the most effective, then getting their point across of what they want instead of coming up and making a, you know, and making a request.”
Personnel Factors: Perceptions of the Athletic Training Profession
The inductive analysis revealed that the participants believed many of the bullies tended to have a negative perception of the athletic training profession that manifested in how they treated the ATs. Tiffany, for example, stated, “… my direct boss doesn't recognize… the profession, so things that we ask for… are pushed aside or blown off or… turned on us as being greedy or being needy.” She continued to explain how the coaches view the AT's role:
We're not necessarily viewed as health care professionals, we're viewed as… “coverage monkeys,” that we are basically just here in… “risk management”… it doesn't matter the level of health care we're giving as long as, you know, the teams are happy, that they're getting their ice bags and their water bottles, and there's someone physically at a practice or at a game every single day, that's all we're judged on basically.
In Tiffany's case, the coaches' diminished view of the profession resulted in a lack of respect and poor overall treatment that was perceived as WPB.
Chris articulated how his bully, who was a coach, tended to show disrespect and “talk down” to him by reminding Chris about his athletic training knowledge:
I have particular difficulty dealing with our women's basketball coach… everything that you do, every time you tell him something, he starts his sentence with, well, I've had an athletic training class, so I know a little bit about this.
Ryan, the only certified AT at a midsize National Collegiate Athletic Association Division I university, described an interaction with his football coach illustrating unrealistic expectations not matching the resources available:
… I [the coach] would like for this to be run like an NFL [National Football League] training room, and you know at that point, I just had to let him know right there, number 1 we're not in the NFL, number 2 we don't have NFL resources…
The unrealistic expectations by the coach were not the only frustration for Ryan. He went on to explain a lack of professional respect for his expertise:
In athletic training, everyone feels like they're your boss, and they're supposed to tell you what to do… pretty much at their beck and call when it comes to schedules, practices, game scheduling… all this from [a] bunch of people who really don't even respect you, it's like I'm an overpaid water boy, I don't get the respect and any type of acknowledgment, for doing just the simple things.
Jason tried to conceptualize the workplace interactions between coaches and ATs by stating, “… there's an unfairness to this position and job, you know, and it, and I'll tell you it stems back to I'm a professional and I'm dealing with unprofessional people.”
As a part of the antecedents of bullying, participants identified personnel factors that helped to contribute to the occurrence of WPB. Those factors include the personality of the bully and the bully's perception of the athletic training profession. Individuals with controlling, jealous, or arrogant personalities and those with negative or ill-mannered perceptions of athletic training were identified as bullies by participants.
Environmental Factors
In addition to personnel factors, interviews revealed insight into the nature of organizations that tended to foster and perhaps encourage bullying. These environmental factors included pressure to win and a lack of administrative support.
Environmental Factors: Pressure to Win
Athletic trainers in this study articulated that because of the win-at-all-cost mindset, many individuals were more aggressive in how they interacted with others. For example, in her online interview, Jennifer stated, “I believe that unfortunately, bullying is endemic to the athletic professions. Part of the driver is the need to come in first place. It is something that needs to change.” Mary, in her phone interview, for example, explained a situation whereby her bully pressured her to do what he wanted:
He… stood very close to me and leaned over me and told me… that his job was based on wins and losses whereas mine wasn't, and I was going to put his 4 children out on the street because I was holding this player out…
Mary also described how she became an excuse for the team's poor season:
I interfered with conditioning, so he was angry with the way I… [was] trying to prevent heat illnesses… [he] said that in my mismanagement of or interfering with conditioning that it was my fault that the athletes were not properly conditioned and it was my fault that we didn't do as well this season.
Chris identified how the behavior of the coach was overlooked because of competitive successes:
I think the big thing with him is he's winning, as long as he's winning, until he does something to where he physically puts his hands on somebody, I don't think anything's ever going to happen.
Environmental Factors: Lack of Administrative Support
Participants expressed a lack of administrative support in dealing with a bully. When Mary tried to address a bullying problem, she was disappointed with the results:
I tried, I tried to do what I thought would be the best, which was to utilize the chain of command, but I just don't feel like I got any support from them [administration], so I don't feel like that was very effective.
Ryan had a similar situation:
Instead of communicating with me, the coach immediately [ran] to the athletic director complaining about, um, my abilities as an athletic trainer… when I actually talked with the athletic director, you know it seemed… like water on a duck's back… nothing he [AD] could really do, something that they, you know, been doing forever, you know, all kinds of excuses. It was very much like the athletic director was there to accommodate the coaches, of course, but it always seemed like the coach was always asking for some outlandish request.
Other ATs experienced a worsening of the bullying because of their whistle blowing. Tiffany explained her experience:
Yes, we've [athletic training staff] both gone to the HR [human resources]. They were appalled at some of the things that I had reported and were very understanding and sympathetic to my issues. But they encouraged me to schedule a meeting to try and work on it, which only made matters exponentially worse. Two of them [AD and assistant AD] came in as this united front and basically painted this horrible picture of me as an employee, subsequently resulting in my being put on probation. So it [reporting the bullying] actually was the worst decision I ever made. I should have reported it and left it at that. Trying to fix it led to retaliation and led to more issues, led to an even more intense microscope of every single thing that I ever do because now all of it's documented and at any point if I slip up I could be fired.
Some ATs chose not to report the bullying. When asked if she reported the bullying, Susan answered, “No, I didn't report it [the bullying] because I didn't feel like there was anybody I could report it to.” Susan indicated the supervisor of her bully would not look at the situation objectively and therefore nothing would change. This feeling was corroborated by Jason, who stated, “… nobody wanted to handle the coach because… I think they understood that nothing was going to change who he was…” Finally, Ryan illustrated how administration could ignore even blatant circumstances:
Then it dawned on me… I am literally the fourth athletic trainer to come to this school in a year's time… natural to feel like the administration was aware of the difficulties, and just statistics say if you got 4 athletic trainers in less than a year's time, that maybe there's something that's a problem at the environment, not the athletic trainers... the administrators kind of bury their heads in the sand if you will…
During the inductive analysis, the antecedents of bullying were described. This relationship partners the subthemes of personnel factors and environmental factors. Participants indicated personnel factors included the personality of the bully and the bully's perception of the athletic training profession. Personality characteristics such as the need to be in control, jealousy, and arrogance were identified as contributors to the occurrence of WPB. Also outlined were the environmental factors of pressure to win and lack of administrative support. Examples of antecedents of bullying included coaches trying to prove themselves, athletic directors thinking they knew everything, and administrators retaliating for previous embarrassments. A graphical representation of the antecedents illustrates the interaction between personnel factors and environmental factors with regard to WPB is presented in Figure 2.
Consequences of WPB
The second emergent theme from the interviews was how WPB affected the victims after the occurrence. These consequences of WPB were divided into the subthemes of (1) increased stress and anxiety, (2) feelings of inadequacy, and (3) increased distrust.
Increased Stress and Anxiety
In response to the bullying experienced by ATs in this study, many reported increased stress and anxiety being expressed in a variety of manners. Susan described the emotional symptoms she experienced:
Well I've cried a lot, been very stressful… I worry quite a bit… what am I going to do about that, so these are things that sometimes keep me up at night, some nights I don't sleep very much, other nights I could sleep alright.
In her phone interview, Erica voiced her stress and confusion: “Yeah, I think I am just mentally beat down, and going, ‘How in the world could adults do this?'” Tiffany shared her cascade of emotions:
For a while when things were really bad it was debilitating… it affected my social life… it was just so exhausting… I would try to talk about it with my roommates, but it was just the same thing over and over again, so it eventually started to affect that relationship. Every time I would go out with coworkers or friends in the area… it basically was the only thing that was ever really discussed and so I was dealing with it at work and dealing with it in my private life and it was just overwhelming… it was kind of the same stuff over and over again, just stopped talking about it.
Ryan was employed in his position for only 5 months, but he illustrated the effects of WPB: “I guess all that stuff [WPB] that happened during that time, it was so dramatic it was just so… intense that it has a way of just kind of running ruts in your psyche.” Several ATs described how the uncertainty about when the WPB would occur was stressful as well. Mary described her feelings:
I get so worried and stressed out about having any sort of interactions with him [women's soccer coach]… the stress, the “emotional hangover” of having to deal with him has been consistent for the last 2 years.
Similarly, Tiffany expressed how the uncertainty affected her:
We get in there [the athletic training room in athletic department]… we're under a microscope, everything's overanalyzed… one day you might do something 1 way and it's totally fine, and then the next day you do the same exact thing, and for some reason it's wrong today… there was no consistency, no expectation… you kind of had to hope that you just didn't get in trouble that 1 day.
Finally, Mary illustrated how the stress trickled into other aspects of the ATs' lives:
Personally it was a huge problem… I was definitely having some major cognitive behavioral things. I was having insomnia… I'm a stress eater… I have had some issues with my husband… he finally told me actually just recently that he was tired of me being grumpy every time I came home because of my job.
Feelings of Inadequacy
In addition to stress and anxiety, WPB victims expressed feelings of inadequacy. In his online interview, Steven stated, “It made me mad and also made me question my abilities,” and Mary noted, “I felt it affected my confidence… and my ability.” After losing her job because of bullying by her supervisor, Susan described her feelings of inadequacy for future employment:
When I was hired on as program director here 12 years ago, there weren't many PhDs in the field; now if I look for the same type of job I'm not qualified, I don't have the terminal degree, and some places even for clinical coordinators are looking for hours past a master's that I don't have [and] I haven't been an active clinician day to day for 16 years.
Finally, Alison indicated in her phone interview how the effects of WPB lingered even when a bullying incident was not actively occurring: “It's not that he's saying I did something wrong, I just perceive that my work, like what I did wasn't good enough.”
Increased Distrust
The final consequence of WPB presented by ATs in this study was an increased distrust of others. As a result of her WPB, Erica stated she “definitely [had] a sense that you couldn't really trust people.” Ryan substantiated this by testifying how working with a bully leads to a level of distrust of individuals “just having your head on a swivel, you know, just really looking for that person that has that attitude or that mannerism.” Because of the position her bully held and the resulting actions of administration, Susan's distrust encompassed an entire group: “I certainly don't trust any of the administrators, I've found them to be liars.” Finally, Alison communicated a general distrust of people and their motives:
People use information to benefit themselves… and it's been done where there, it's like Alison said this… [then] you're caught and… I feel I have to defend myself, so I think I keep a lot to myself.”
Participants in this study who had experienced WPB shared a variety of consequences. Workplace bullying events resulted in higher levels of stress and anxiety, which often manifested as physical and mental ailments. Participants also communicated how being bullied attacked their confidence and resulted in feelings of inadequacy. Finally, interviews revealed how victims experienced an increased distrust of those around them in the workplace.
Coping with WPB
Whereas the previous section outlined the second emergent theme, consequences of WPB, the third emergent theme identified the 2 subthemes that helped the victims cope with the WPB. The 2 subthemes identified were emotional resilience and avoidance.
Emotional Resilience
Participants experiencing bullying were affected in a variety of ways. Seasoned ATs such as Jason and Shawn communicated how experience in the athletic training profession can enhance the emotional resilience of a victim. Jason, an AT employed at the same university for over 20 years, stated:
… I've been here long enough that they… know I don't back down… they may come in and scream and yell… and sometimes [I] have to say what part of “n” or “o” don't you understand? You know… yelling louder and saying it differently doesn't change my answer, it's still no… I've actually walked a coach out of my office and closed the door because they didn't want to hear… I've heard what you're going to say, I've been professional in that respect and now it's over, I've given you my answer… you just got to learn to deal with it.”
Shawn, an AT with 3 decades of experience, made a similar statement:
Well, I guess I've hardened to it over the years... I saw it as a youngster and got used to it I guess… I think I've chosen to make the best of a difficult situation. I've put the bullying aspect if it's not harmful… I'm just going to stay out of it until it becomes a health issue.”
When asked about coping with WPB, Chris, an AT in his 50s, commented, “Experience… I've done it so long that I've learned to just circumvent things and go around things and I've learned what not to do…” Chris also shared how he used the WPB as motivation:
This makes me work harder, I'm that type of person… I've made a conscious decision on my part to not let him just absolutely ruin my entire day just by his mere presence… I try not [to] let him affect me, my personal life, and what I, and how I do my career… He has enough effects on me during basketball season; I'm not going to let him do it the rest of the time… This is the first I've talked about this outside of basketball season, I mean, once basketball season's over, I just kind of, you know, flush him down the drain, I don't have to worry about him until the next year.
The same theory of turning the situation to the victim's advantage was exemplified by Ryan, who was using the WPB as a learning experience: “… instead of looking at it like the scar on my career… it was a very eye-opening experience, and it has really taught me a lesson on how to deal with that particular attitude, and I hope I never have to deal with it again.” Alex used his years of experience as an educator to compartmentalize the WPB:
You know I think the thing I've been able to do was to make sure while I'm in the classroom, there's no issue, I mean it's just, it's just me and the students, and I think I've tried to maintain my focus on doing what's in the best interest of our students, and um not bringing any of those negative interactions to bear on that process, the teaching and learning process.
Tiffany's WPB experience helped her to unify a group of victims against their bully:
… once I kind of took the route in going through HR and kind of sharing my experience with some of the other staff members in the department, more and more people started to say I feel that way too, I feel that way too, this isn't just happening to me, listen to all my stories… so actually now the tables have turned and the staff has a united kind of agenda um towards our athletic director… because the rest of us rallied together and created a united front.
Emotional resilience was an important factor in the effect a WPB experience had on a victim by providing the victim some control over the situation. Victims used experience, compartmentalizing, and future learning as techniques to increase their emotional resilience. If increasing the emotional resilience of the victim was not possible or effective enough, often the victim tried avoidance as a strategy.
Avoidance
Several ATs in this study communicated how avoiding the bully made dealing with the WPB more manageable. Chris limited his interaction with his bully, the head coach, by communicating more with the assistant coaches:
Unless he asks me questions, I try not to interact with him… unless he absolutely approaches me and wants something, you know I try not to interact with him. I do my very best to give the, my injury reports to his assistants so I don't, and if [he] wants to know more about them, then he can come ask me.
Ryan's experience with WPB was so negative that he was considering avoiding the entire collegiate setting: “I'm not the problem, you know, it's just I ran into a bad situation, and again, thinking about going into a college setting again, it feels kind of shaky, you know.”
Athletic trainers in the educational setting articulated similar methods of avoidance. Erica expressed her apprehension about collaborating on a research project:
I've delayed a research project that could really get going, but it requires participation from a faculty member that I think was involved in the initial rumor mill… “Why would I want to engage in a research project with you because if I can't trust you for simply not saying something that is just inconceivable, then how much can I trust you with data?”
Alex identified how he had limited some of his service activities to avoid his bully: “From a service standpoint, there's some committees I've probably would have chosen to be on, but didn't because I knew this individual's on that committee…”
The participants in this study used 2 techniques to cope with the WPB. Several respondents described how their years of experience in athletic training enhanced their emotional resilience, whereas others used protective compartmentalizing to increase their resilience. Finally, avoidance was reported as a strategy to minimize the effects of WPB. Reducing the interactions with the bully by communicating with assistant coaches, not volunteering for committees, or delaying research projects were all ways to avoid the bully.
Lack of Training on Workplace Environment
The final emergent theme communicated by the ATs in this study examined the training received during their educational or professional background. When asked if they had received any training regarding the workplace environment, almost every participant answered no. Alex relayed his opinion on the prevalence of WPB in athletic training:
My initial gut is it happens more than we might think, and I think for a lot of folks they might chalk it up to a little interpersonal conflict but when you, but when it's pervasive and it keeps happening, and you know it starts to, starts to really rear its ugly head…
Several respondents reported that they had received training focused on how they should treat athletes but no training on how the AT should be treated in the workplace. Mary pointed out,
I can remember having conversations about how to [interact with] difficult coaches, but I don't think I had any really specific training, I think maybe… a class discussion about discrimination, but I think most of it was like, you know, you don't discriminate, not how to handle discrimination that you witness.
Shawn, a leader in the athletic training profession, pursued training in psychology during his doctoral program, but he stated, “… a lot of athletic trainers are thrown in the middle of handling these situations and we're really not prepared for it.”
Other participants provided insight on how to address the problem of WPB. In Richard's online interview, he addressed the need for infrastructure changes by noting, “I think it needs more attention, and formal steps within a workplace infrastructure for management and accountability.” Shawn provided an organizational solution to control the WPB:
… my biggest concern is that in many places, athletic trainers have no control [over] this type of activity in the sports medicine setting, it's going on in the training room, affecting what's going on, on the sidelines. Athletic trainers need more control in a decision-making position rather than just being totally dependent on what the coach or AD wants.
Finally, Jason expressed his thoughts on how beginning to address WPB is important in athletic training:
… the fact that it won't stop in this situation, in our situation, until the administrations, you know, step up, whether it be the president's office or the vice president's office or the AD's office steps up and goes you're not going to act that way, that's unacceptable, you know it's unacceptable for you to feel that you have the right to verbally abuse somebody because you don't like something, that's not professional, that's not how you handle things… if you feel like you have to bully things, then you don't belong here, if your only way of getting something is screaming, yelling, and demanding, you know you need to, you know you need to change, now maybe we should offer them help, I don't know if that would work, because they don't recognize the problem, they're not going to ask for help.
DISCUSSION
The purpose of our study was to explore certified ATs' perceptions of WPB in the collegiate setting. Participants completed 15 interviews providing data concerning their experiences with WPB. The inductive analysis resulted in 4 emergent themes: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of workplace environment training.
Antecedents of WPB: Personnel Factors
The personnel factors identified as precursors to WPB consisted of the personality of the bully and the bully's perceptions of the athletic training profession. In this study, participants described a variety of personality characteristics, such as the bully's being controlling, jealous, retaliatory, insecure, arrogant, and self-centered. These personality traits are consistent with those cited in previous research. Murray,18 for example, identified how bullies need to be in control or have a personality flaw such as extreme stubbornness, exaggerated sense of self, or a lack of remorse or guilt regarding the harm inflicted upon others. This was corroborated by Goodman et al,49 who shared a participant quote that underscored the controlling nature of others:
I felt like the coaching staff put themselves against the athletic training staff quite a bit... instead of just coaching, they're telling you how to do your job and that sort of thing... There was one [instance] where I was like, “You and I disagree on this, but my job is to intervene in the best interest of the athlete.”(p293)
In addition to the personality of the bully, the inductive analysis revealed that many of the bullies tended to have a negative perception of the athletic training profession that manifested itself in how they treated the ATs. This finding confirms the results of a 2010 study by Goodman et al,49 who studied female ATs in a collegiate setting. Participants in that study described a general lack of respect and appreciation from coaches as well as being questioned about their education and medical judgment.49 In 2005, Mensch et al50 found coaches had limited knowledge and understanding of the athletic training profession, including the experience, preparation, and qualifications of certified ATs. This lack of understanding tended to limit the role of the AT.
Antecedents of WPB: Environmental Factors
Athletic trainers in this study articulated that because of the win-at-all-cost mindset, many individuals, particularly coaches, were more aggressive in how they interacted with others, and this tended to precipitate WPB incidents. Pitney39 observed that the pressure to win in the intercollegiate setting created an unsettling environment for ATs. In our study, these pressures seemed to be a factor associated with the WPB incidents, particularly when administrative support was lacking. Participants experienced a lack of administrative support in dealing with a bully. In comparing this finding with the existing literature, it appears that a lack of administrative support is not unusual.
In a study conducted by the Workplace Bullying Institute, for example, participants who reported a WPB incident stated that in many instances, nothing was done by the administration.8 Quine51 observed that 67% of participants experiencing WPB in the past 3 months reported the WPB, but 74% of those were not satisfied with the outcome. A participant in a 2008 study by Strauss52 noted that the facility administrators did not address the WPB problem. In the same study, another participant reported, “She [the director] was a direct witness to this assault and did nothing about it!”52(p25) A lack of organizational support can produce negative effects on a health care provider,53 whereas support from supervisors and colleagues helps to minimize stress.54 Finally, Pitney39 specified, “an organization's culture and structure can influence the wellness of the professionals employed.”(p193) Research by Mazerolle et al42 also supports the role a supervisor can play in influencing the organizational culture. Goodman et al49 stated, “a perceived lack of organizational support, specifically stemming from the supervisor (primarily Head AT)… ultimately contributed to the attrition…”(p294)
Consequences of WPB
In response to the WPB experienced by ATs in this study, many reported increased stress and anxiety, feelings of inadequacy, and an increased distrust of others. As previously stated, WPB victims suffer physical and mental effects that can last long after the WPB stops.24 Previous investigators55–58 of WPB have found (1) higher turnover, retention, and recruiting, including earlier retirements; (2) higher absenteeism and health costs; (3) reduced productivity; (4) counterproductive behavior (ie, sabotaging or theft); and (5) increased legal action by employees. According to Elias,59 one-third to one-half of all stress-related illnesses were directly related to WPB. Several participants indicated physiologic stress-related illnesses such as migraines and disturbed eating patterns. This finding is consistent with previous research describing not only the conditions previously listed but also hypertension, gastrointestinal problems, and chronic fatigue.60 In addition to physiologic stress-related illnesses, victims also experienced psychological symptoms of low self-esteem, anxiety, sleep disturbance, recurrent nightmares, concentration difficulties, irritability, feelings of depression, and self-hatred.14
Coping With WPB
Participants experiencing WPB were affected in a variety of manners. Emotional resilience is an important factor in the effect WPB has on a victim by providing the victim some control over the situation. Victims used experience, compartmentalizing, and future learning as techniques to increase their emotional resilience. If increasing the emotional resilience of the victim was not possible or effective enough, often the victim tried avoidance as a strategy. Several ATs in this study communicated how avoiding the bully made dealing with the WPB more manageable. Reducing the interactions with the bully by communicating with assistant coaches, not volunteering for committees, and delaying research projects were all reported as ways to avoid the bully. In research by Mazerolle et al,42 participants suggested avoiding conflict by setting boundaries. Although this study related to work–family conflict, setting boundaries with others can articulate what one is and is not willing to tolerate. This may play a role in mitigating the number of bullying incidences. Mazerolle et al42 stated, “By establishing boundaries, such as setting treatment hours, saying no, or having specific call times, an AT can effectively do the job while still having a personal life.”(p200)
Lack of Training for the Workplace Environment
Participants in this study had minimal, if any, training related to WPB or harassment in the workplace. They felt that WPB was more prominent than was actually reported and that any training received was focused on how the AT should treat the athletes or coaches and not on how the AT should expect to be treated in the workplace environment. Interviewees also provided possible resolutions to the problem of WPB, including formal steps and accountability within the infrastructure and ATs' holding more decision-making positions. Finally, 1 interviewee challenged administrators, from the athletic director to the president's office, to step up and prevent bullying from occurring. This was also illustrated by Goodman et al,49 who suggested the implementation of more training on conflict resolution to help improve the quality of life for ATs.
Limitations of the Study
The most significant limitation of our study was the lack of generalizability to other athletic training populations; however, as with most qualitative research projects, the information may be transferable for a reader in a similar context. Also, participants were limited to National Athletic Trainers' Association members in the collegiate work setting, and the findings here may not represent other work settings. Finally, although WPB is an organizational concern, the perceptions of those affected by WPB are individualized.
Implications and Future Directions
As a result of this study, several participants provided information regarding personal experiences with WPB in athletic training. In essence, a dialogue was started regarding WPB in athletic training. We hope the primary implication of this study is to introduce the topic to the world of athletic training and provide those experiencing WPB a sense of solace in the knowledge that they are not alone. We recommend ATs empathize with victims, as they may feel vulnerable, experience self-doubt, or struggle with the stress of WPB. The AT should extend a hand of support to coworkers and model a high level of respect toward and expect the same respect from others.
Because some of the WPB incidents noted in this study stemmed from a lack of respect for the AT profession on the part of the bullies, more education about the AT profession is needed. Seven years ago, Mensch et al50 reported a lack of coaches' understanding of the qualifications, experience, and professional preparation of ATs. Participants in this study made similar statements regarding their current situation. As a result, we recommend further communication and education between ATs and coaches or administrators. We understand that some situations will not be “fixed” by the added measures, but the possibility of added administrative support seems worth the effort and may reduce the incidence of WPB.
In an effort to prevent the occurrence of WPB, we suggest the creation of athletic training–specific case studies for use in continuing education workshops and by athletic training educators to increase the personalization of WPB. Moreover, a better understanding of the qualifications, experience, and educational preparation of ATs could be cultivated in university administrator populations. Such a program should be included in procedural handbooks; beginning-of-the-year orientation for athletic training students and student–athletes; and the posting of policies in highly visible areas around the athletic training room, locker rooms, and athletic training classrooms.
Future researchers should focus on exploring the physical and emotional effects that WPB has on the individual AT. Investigations should be conducted in other athletic training settings, including high school, clinical, industrial, military, law enforcement, and performing arts environments.
CONCLUSIONS
Usually, the unique work setting of ATs involves professional and mutually respectful interaction with a variety of populations and personalities. However, our findings illustrate that unpleasant and unprofessional interactions occur and identify the antecedents contributing to WPB, the consequences of WPB, and the coping strategies of its victims. As the profession of athletic training continues to advance in competence and respect, we need to continue to foster the education of others on the role of ATs as health care providers and underscore the acceptable professional interactions that should occur in an organizational setting. Although further research in WPB will provide additional information on the occurrences and effects of WPB in athletic training, all ATs can begin to combat WPB starting today. Introspective examination of our behaviors, coupled with the outward display of respectful behavior and zero tolerance of unacceptable behavior from those around us, will begin to change our work environments.
Workplace bullying interview guide. This guide was used with only slight modifications for both those who experienced and those who witnessed bullying. Guide reprinted with original wording. Abbreviation: AT, athletic trainer.
Schematic representation of emergent themes. The overlapping spheres in the antecedents of bullying represent the interaction between personnel factors and environmental factors with regard to the causes of workplace bullying. Abbreviation: AT, athletic training.
Contributor Notes