Athletic Trainers' Barriers to Maintaining Professional Commitment in the Collegiate Setting

Participants

Sampling was purposeful and data saturation guided recruitment of participants.¹⁸ We used professional networking to identify a convenience and snowball sample, which resulted in 33 AT volunteers (National Collegiate Athletic Association Division I = 11, Division II = 9, Division III = 13). We solicited participation from individuals working within each of the division levels who had been employed in their current position for at least 1 full year. All were full-time employees and certified by the Board of Certification, with an average 10 ± 8 years of clinical experience. Participants represented 8 National Athletic Trainers' Association districts; Districts 5 and 8 were not represented. The highest educational level achieved by 29 of the 33 participants was a master's degree. Demographic information and the participants' pseudonyms are provided in the companion article.¹⁷

Data Collection and Analysis

Once we obtained institutional review board approval, we collected data using QuestionPro (QuestionPro Inc, Seattle, WA), a secure data-tracking Web site. All participants were asked to respond to a series of open- and closed-ended questions derived and borrowed from existing literature.¹⁰ We conducted a peer review and small pilot study before data collection. The peer review provided us with a content analysis, ensuring that we developed an accurate, realistic, and appropriate interview guide to help us answer our intended research purpose. The peer brought knowledge in the area of professional commitment, social behaviors and attitudes, and qualitative inquiry. The review resulted in the addition of several questions and grammatical edits. Upon completion of the peer review, the instrument was pilot tested. The pilot test revealed no concerns, confirming the peer's review of the instrument. Data collected in the pilot test were included in the analysis because no edits were made to the instrument or procedures.

We used an inductive content analysis with the textual data following procedures outlined by Pitney and Parker.¹⁸ We selected this analysis procedure for its intended purpose of uncovering emergent themes and patterns in the data as they relate to a specific research question.¹⁸ Common concepts were identified during the constant comparisons of the data and eventually were grouped and labeled with codes that reflected the meaning of the theme. Consistent with our procedures in the first paper,¹⁷ for a theme to be established, coded concepts had to be cited by 50% of the participants. This method is consistent with a previously published qualitative study¹⁰ of other similar qualitative studies.

Establishing Trustworthiness

We established data credibility using 2 strategies as described by Pitney and Parker.¹⁸ First, multiple-analyst triangulation was performed: 2 researchers independently examined the transcripts, coded them, and generated emergent themes. These researchers conveyed the meaning of the codes to one another and how they populated the various themes and then negotiated the ultimate construction of each theme. A peer reviewer examined the transcripts and coding sheets to verify the findings and ascertain data credibility. The peer provided credibility to the analysis due to his previous experiences as a qualitative scholar and editor.

Life Stage

The life stage theme reflects the idea that, as an individual grows professionally and personally, there is a chance for spillover between the 2 domains of life, particularly with respect to responsibilities at home. Specifically, outside factors such as children and marriage, among others, may affect professional commitment, as highlighted by Annie's response to her overall commitment to athletic training. She commented, “Outside factors that are happening in your life could affect your overall commitment to the job.” Alisha reflected similarly: “As outside responsibilities pile up, there are days when it is hard to focus at work and give it your all.”

Zach, a Division III AT with 7 years of collegiate experience, highlighted the influence family had on his professional commitment, particularly in combination with work hours. He noted:

Yes [my home life affects my professional commitment]. I live an hour from work and already work extremely long hours. I rarely see my 9-month-old son and wife. That makes it difficult to want to be at work, regardless of how much I enjoy what I do [as an AT].

Personal and family concerns beyond the day-to-day responsibilities of family life were discussed as influencing professional commitment by Devon, a Division II AT. He shared a personal experience:

Personal problems with family can cause a lot of stress, and it really kills your motivation level. For example, last semester, my wife filed for divorce and moved back to [state] from [state], leaving me behind and alone. She is also pregnant with our first, so that really caused me to want to be in a different place.

An individual's career and life-path trajectories can alter the assessment of satisfaction and commitment to a particular role and accompanying responsibilities. Professional commitment can be negatively influenced when outside factors are perceived as stressful or when they, too, require time and energy that may not be available due to work expectations and hours.

Work Overload

Our participants described times of frustration and wavering professional commitment and enthusiasm when their workloads were at high levels. These problems were mostly due to the large number of hours the participants were required to work in the collegiate setting. Aidan, a Division III AT with 3 years of experience, highlighted work overload due to the hourly requirements of the collegiate setting: “My schedule is not conducive to having any sort of social life (My hours are bad even for an athletic trainer, since I am in-season year round.).” Similar comments were made regarding times of reduced professional commitment by other participants, including those in the Division I and II settings, as demonstrated by the ensuing 2 quotes by ATs with 12 and 6 years of experience, respectively: “Working a semester of mostly 12-hour days and minimal days off due to practice schedules,” and “Working 70 hours per week during the 3 months of multiple sports, teaching classes, advising students—it can leave me thinking about a ‘9-to-5’ job.”

The preceding quote speaks to the effect of role strain and overload, whereby multiple roles and responsibilities require significant time and energy to complete, leading to long work hours. Kaleb, a head AT at a Division III institution, provided context regarding professional commitment:

I think for me, it [professional commitment] comes during times when athletic schedules are very busy, there are many games back to back, high travel, and late practices. When this perfect storm comes together, it is very stressful and you begin to question your enthusiasm and commitment.

Professional commitment, which Ari described as “loyalty to my profession, coworkers, and especially to my student-athletes, who deserve the best medical [care] and rehabilitation that I can offer” is often influenced negatively when the AT is working long hours and managing multiple responsibilities. Many participants experienced wavering commitment for these reasons, and those working in each of the 3 divisions were affected by work overload.

Organizational Climate

For this group of ATs, professional commitment was linked to administrative understanding and the chain of command in the athletic department and organization. The reflections of our participants suggest that communication and hierarchy, when ineffective, can reduce professional commitment. Zach said, “I work at an institution where athletic trainers are rarely considered in any decision-making processes, and we often get told to ‘just deal with it'.”

A frequent complaint is that coaches often change practice schedules and forget that ATs cover multiple sports. When asked about changes that could be made to improve her professional commitment, Angela shared:

I would change the overall attitude in Division I athletics. Coaches, administrators, and sometimes even the student-athletes—they believe they ‘own' us, in a sense. That we are at their mercy—coaches can call last-minute practices, demand treatment times, etc. I would love to see the collegiate athletic trainer[s] have the option to have more life outside of the demands of their jobs.

Angela's comments illustrate the need for effective communication within the athletic administration, as well as the importance of respect among the team players, to help create a sense of commitment.

A supervisor's influence was also noted as affecting an AT's professional commitment and perceptions of commitment. For example, regarding his supervisor's attitude and its effect, Ian stated, “My supervisor is miserable and takes all her frustration out on her surroundings.” Ian's professional commitment was negatively affected by his supervisor's lack of support: “[N]one of my supervisors have encouraged me to stay in this setting.”

Ian went on to describe the struggles in a work environment that included negativity and difficult relationships. “My boss and coworkers make coming to my job a nightmare, and I have adopted their attitudes. I feel very sad that this has happened. I'm fighting a losing battle and I just don't care anymore.” As described by our participants, the organization—specifically the facets of communication and supervisor support and outlook—can negatively influence an AT's perceptions of professional commitment.

Some of our Division I participants alluded to the notion of continuance commitment. The idea of weighing the costs and benefits of staying in a position was mentioned by Chris, who said, “Our profession is at a crossroads: do we continue to be abused by coaches and admin[istration], or do we take a stand now?” When asked what personal strategies are used to sustain professional enthusiasm, Seth bluntly responded, “Mostly a lousy economy, it makes even this job seem good when compared with unemployment and homelessness.” The organizational climate, which encompasses the patterns of behavior and attitudes and feelings of an organization, can decrease one's professional commitment, especially when coworker dynamics and communication are ineffective or dysfunctional.

Human Resources

Our participants spoke of the need for more support in terms of staff members to adequately cover all the responsibilities related to medical coverage and administrative loads. For example, Aidan said, “More ATs at my institution would help, so that we are not spread so thin, and perhaps I might be more enthusiastic about getting better, as opposed to trying to get by at times.” The participants, regardless of collegiate level, consistently discussed the need for more full-time staff members to help reduce their loads and improve the work environment, which would enhance their professional commitment. Whitney, a Division I AT, noted,

We have a fairly small sports medicine department with no graduate assistant ATs or student program. If we had the funds to hire additional staff so that I went from having 2 teams down to just 1, I could focus more on my professional commitment to that team.

When asked what could be done to improve her professional commitment, Jenn, a Division II AT, explained:

More staff equals more time to pursue enrichment; less stress, less time commitment, more time away from work equals happier, more enthusiastic, and more willing to be a positive and engaged in professional commitment.

A reduction in responsibilities because of adequate staffing was also mentioned by Kristen, who was working in the Division I setting:

Every athletic trainer should only have to work 1 sport all year long. Having multiple sports and student-athletes makes it very hard to try and do everything needed, rehabilitation wise, and when you only have a limited time to do it, and they all need individual time.

Professional commitment not only encompasses completing professional responsibilities but also involves giving back to the profession itself. Hiring additional staff members to reduce or equalize the AT's workload was also cited as important to help the AT become more professionally involved. Sean said, “Hiring additional full-time staff members to allow all of us the opportunity to be more involved professionally.”

Our participants identified life stage, work overload, organizational climate, and human resources as barriers to continued professional commitment. Three of the 4 emergent themes were organizational items and concerns; life stage reflected the personal influences that can affect one's professional drive and commitment. The themes presented were the dominant concepts discussed by at least 50% of our participants as a factor in reducing their professional commitment.

Life Stage

It is not surprising that our participants found a connection between their professional commitment and their life stages. Authors¹⁹ who examined work-life balance, a form of role conflict, found a link to life stage, particularly among men and women who were balancing parenting roles and paid work. Our participants' experiences with wavering professional commitment highlight the idea of a “spillover” effect, such that family or personal role demands can create stress and take away from work time. The spillover of family and personal demands decreases the individual's professional commitment. Although buffering can happen, whereby satisfaction in one area of life can reduce distress from another role, the demanding nature of athletic training may not allow for this to occur. Marital status and ages of children have been linked previously to nurses' professional commitment; that is, those who were married and had younger children were more likely to struggle with professional commitment.²⁰ Thus, our findings illustrate that when multiple roles are extremely taxing of both time and energy, professional commitment can be negatively influenced. As reported by Pitney,¹⁰ time away from the role of the AT can lead to rejuvenation and a renewed sense of commitment, so when an AT is unable to spend time engaged in non-AT roles, a reduction in commitment is very likely. Moreover, the notion of resiliency has been linked to the ability to persist, survive, and thrive in the face of emotional or physical stress, which is stimulated by role strain and conflict. As discussed by our participants, resiliency can be enhanced when balancing parental roles, personal obligations, and work within the collegiate setting.

At the individual level, the AT must identify strategies that can help him or her absorb the stresses associated with the various roles assumed in life, such as maintaining a healthy lifestyle, exercising regularly, engaging in leisure activities, and meeting personal and family needs.¹⁰ Schedule modifications may be helpful for the AT to gain a sense of control and manage roles outside the workplace more effectively. In fact, as described by Pitney,¹⁰ giving an AT autonomy over scheduling can be seen as a reward for commitment and hard work in the AT role. Time away, especially when engaged in leisure or personal interest activities, can also facilitate an AT's rejuvenation and, thus, is another important strategy to foster professional commitment. To promote professional commitment and resiliency, organizations should promote a cohesive workplace, most notably through teamwork and effective communication, encourage healthy behaviors in their ATs, and provide a reasonable amount of flexibility or time during the day for nonwork-related activities to help reduce possible burdens.^21,22

Work Overload and Lack of Human Resources

Work overload has been reported within athletic training, specifically in the Division I setting.²³ Overload can precipitate a reduction in professional commitment by reducing the level of job satisfaction, a direct facilitator of persistence and retention in the workplace.²⁴ Our participants believed that work volume contributed to any depreciated career commitment they experienced. In collegiate athletics, the nature of the work, which is an underpinning of job satisfaction and professional commitment, is often institutionalized as working excessive hours and having little flexibility or autonomy over work scheduling.^25,26 The demands of collegiate athletics are often apparent in the work lives of ATs, who typically surpass 40 hours per week and have little autonomy over work scheduling.⁹ Our findings regarding work overload support previously published studies^27,28 in the health profession literature that linked work overload to reduced professional commitment. Although the landscape of the American workplace is characterized by longer work hours than in other countries, several strategies (ie, reinvestment strategies) can help an individual manage professional demands and possibly mitigate the negative effect on career commitment.²⁹ Reinvestment is a reflective and creative means for the AT to help promote a continued sense of commitment and can be achieved simply by carving out personal or “me” time.³⁰ “Me” time has been shown to rejuvenate the AT and promote professional commitment.¹⁰ Other proven methods include peer and coworker support and acknowledgment of achievements by colleagues, supervisors, and patients.^10,30

Our participants also cited a lack of resources, specifically of staff ATs, as a negative factor. Inadequate staffing has been addressed as problematic in the collegiate setting because many sports medicine departments fail to meet the appropriate medical coverage guidelines established by the National Athletic Trainers' Association.³¹ High student-athlete : AT ratios have been reported and often factor into an AT's decision to depart the profession.^4,16 Simply put, insufficient staffing likely means a higher volume of work for other practitioners. A key concern here is that job demands such as overload are not only related to diminished commitment but also to one's intent to leave. Social support, especially from coworkers, is necessary to help the collegiate AT balance multiple roles, because it provides flexibility and, at times, job sharing^9,32; however, when the full-time staff within the sports medicine department is inadequate, capitalizing on this support may be difficult. Employers looking to create a workplace that promotes commitment and longevity should try to ensure that adequate staff is in place for patient care. Furthermore, as outlined by the Robertson Cooper model,³³ creating a workplace that cultivates resiliency, a likely facilitator of professional persistence, requires support and flexibility, which necessitates an environment with sufficient staffing. The Robertson Cooper model reflects an organization's ability to retain employees by cultivating an environment that provides a balanced workload, strong work relationships, healthy workplace conditions, and employee resiliency.³²

Organizational Influences

Athletic trainers identified not being included in decision making, having no control over schedules, and lack of supervisor support as organizational influences that negatively affected their commitment. Autonomy over work schedules and supervisor support are strategies that positively influence work-life fulfillment,^9,32 and because of the relationships among work-life balance, intentions to stay in the profession, and job satisfaction,^5,12,19 our findings seem likely and reasonable. These organizational influences, as identified by our participants, included a lack of respect from organizational personnel that even trickled down to the level of respect shown to ATs by student-athletes. Bureaucracy associated with the Division I setting is an organizational influence that has been reported as a stressor faced by ATs.³⁴ Over time, the nuances of dealing with those concerns can lead to a decreased sense of commitment. Pitney¹⁰ identified respect from others and intrinsic rewards, such as simply being appreciated for one's work, as having contributed to the commitment of secondary school ATs to their profession. For our participants, a lack of respect experienced in the workplace had an adverse influence, resulting in a diminished level of commitment. This result speaks to the importance of having support and recognition in the workplace to promote a sense of confidence, purpose, and belonging, all factors related to resiliency and persistence.³³

Multiple responsibilities (eg, patient care, teaching, clinical supervision), limited time for personal rejuvenation, high patient volume, and limited resources can challenge the professional motivation and commitment of the AT, especially if endured for an extended period of time.^5,6,8,35 The negative consequences related to these professional demands may include burnout, work-life imbalance, and role strain, factors previously reported within the profession and the collegiate athletic setting.²⁴

Additionally, our participants in the Division I setting brought up the idea of continuance commitment through their journaling. Individuals with continuance commitment continue in a role because of the consequences that leaving would bring.³⁶ Recently, Eason et al³⁷ demonstrated that, although levels of commitment did not differ among collegiate ATs, continuance commitment was more prominent than normative commitment based on Likert-scale responses. Therefore, the ATs in our study may not have related to their organizations and may not have adopted the beliefs and attitudes of those organizations. Although our study design did not allow us to explore this finding, perhaps feeling overworked negatively affected our participants' perceptions of organizational culture. Normative commitment tells us that an individual will remain committed because of enthusiasm for the role. Continuance commitment, on the other hand, specifically refers to the cost : benefit ratio. The ATs in our study may have remained in their roles based on perceptions that it was more advantageous and less costly to stay versus leaving.

Our qualitative results support this continuance commitment among Division I ATs, but we did not pursue qualitative data to address this topic among Division II or III ATs. Future research is warranted to discover if differences exist among the settings. It is possible, however, that Division I ATs experience more role strain than their Division II or III counterparts and that they perceive more work overload and human resources concerns. A large body of research^{6,9,12,15,32,37–40} has examined burnout, organizational influences, retention, and work-life balance among Division I ATs. Moreover, future investigators should identify why many Division I ATs perceive that remaining in the profession is a better decision than leaving and should scrutinize the Division II and III settings to determine why ATs working in those settings report lower continuance commitment than their Division I counterparts. Differences among division participants regarding continuance commitment are an interesting finding because a large number of hours worked and insufficient financial compensation or other rewards are linked to departure from the profession. An AT who does not receive appropriate recognition for the hours and effort required to meet job demands may consider leaving.

Limitations and Future Directions

Our study is not without limitations. Specifically, we studied a small random sample of ATs working in the various collegiate levels. Despite following the recommendations for a qualitative study and using data saturation as our guide, our findings may not translate to all ATs employed within this setting due to the small number of participants. Future authors should examine a larger sample size within this setting, but to further expand our understanding, we also need to include other occupational settings. Workplace resiliency is a topic yet to be investigated within athletic training, but it may have some relationship to professional commitment. Gaining an understanding of an AT's perceptions of resiliency in the workplace may also help us to develop strategies to cultivate and support professional commitment and retention in the profession. Several factors, such as age and years of experience, have been linked to professional commitment within the nursing literature; thus, future researchers should evaluate these demographic variables, among others, within the athletic training profession. Our study also presents only the perspectives of ATs working in the collegiate setting; although these extend our understanding of professional commitment in athletic training, emergent occupational settings, such as the industrial, military, and performing arts settings, should also be addressed.

Conclusions and Implications

Professional commitment is cultivated from one's emotional attachment to the profession, the sense of obligation to the profession, and the cost : benefit perception of departure from the profession. When studying factors that help to stimulate professional commitment, we should also uncover the factors that can inhibit it. For the ATs in our study, it is apparent that the workplace can have a significant effect on the ability to maintain professional commitment. Our study was aimed at exploring professional role commitment and not organizational culture or climate, yet it is important to note the role of the organization in professional commitment. Our findings make it clear that organizational leaders have the ability to influence the professional commitment of the ATs who work for them; if they desire to retain effective, dedicated employees, they need to make changes at the organizational level. Adding extra staff members in the athletic training department is one solution to the problems of work overload and insufficient human resources.

The theme of life stage also highlights the importance of individual-level factors in maintaining professional commitment. It is important to recognize that ATs are individuals who have outside responsibilities, and these responsibilities need to be balanced with their work roles. Knowing this, ATs should remember to make time for themselves and use strategies to sustain work-life balance to maintain their professional commitment. Time management, communication, and teamwork are important practices for facilitating work-life balance.