Experiences With and Perceptions of Workplace Bullying Among Athletic Trainers in the Secondary School Setting

Phase I

Phase II

Phase I

A total of 44 participants (7.8%) had a bullying score of 2 or higher on the NAQ-R, empirically identifying them as targets of bullies in the secondary school work setting. A higher percentage (12.4%, n = 70) self-reported as targets of WPB. Of those identified as targets by the NAQ-R, 29 (65.9%) were female and 15 (34.1%) were male, though there was no difference between sexes with respect to having experienced bullying (χ²₁ = 1.62, P = .204).

More perpetrators were male (71.6%, n = 48) than female (28.4%, n = 19; χ²₁ = 12.55, P < .001) as indicated by those who self-identified as targets. We also observed a difference in titles, with the vast majority of bullies being coaches (31.3%, n = 21) or administrators (26.9%, n = 18; χ²₆ = 33.82, P < .001; Figure). The Pearson correlation coefficient revealed a significant negative correlation between years of experience and bullying score (r = −.84, P = .045).

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Phase II

Three themes emerged from the inductive content analysis: (1) antecedents of bullying, (2) emotional and physical consequences of WPB, and (3) coping with bullying. Each of these higher-order themes, along with the lower-order themes, is presented with exemplary quotes from the participants. Pseudonyms were used to protect their identities.

Prevalence of Bullying

The prevalence of WPB experienced by ATs in the secondary school setting was lower than for other health care professionals. For example, WPB was between 27%²² and 46%²⁵ in nursing. Among junior physicians, 37% experienced WPB.¹² The prevalence of bullying experienced by ATs in the secondary school setting (7.8%) was also lower than that experienced by ATs in the collegiate setting (14.4%).¹⁶ Perhaps the low level of WPB in the secondary school setting is related to the emphasis placed on curtailing bullying among students in that setting²⁶ or the environment may offer less perceived emphasis on the “winning at all costs” mentality associated with collegiate athletics,²⁷ so tensions and conflicts are limited. Perhaps, too, ATs simply accept that this is part of the culture. Because bullying is often defined as an act that goes undetected^1,2 and is often subtle compared with other workplace acts, such as harassment and discrimination, our sample may not have recognized that it was occurring, thus explaining the smaller portion that reported it. With respect to the perpetrators of bullying acts, our findings were consistent with previous findings¹⁶ in that they tended to be male (70% to 75% of the time) and predominantly coaches.

We found a higher prevalence based on self-reported bullying (n = 70) than on the NAQ-R (n = 44). Other researchers^28,29 have also found differences between these methods in determining prevalence, though the empirical method (NAQ-R measure) commonly results in a higher level of prevalence than self-reports. Participants may have believed their experiences were consistent with the definition of bullying offered on the questionnaire, even though the specific acts cited in the NAQ-R did not precisely capture what had occurred to them. This might indicate the need to explore the development of an instrument for use specifically in the athletic training context.

Factors Associated With WPB

We found that the vast number of bullies occupied roles as coaches and administrators. This is consistent with findings¹⁶ in the collegiate setting. An administrator with authority over an AT creates a power disparity, which is a key facet of WPB.²⁹ Recent nursing research by Vogelpohl et al³⁰ identified those in power positions over staff nurses (eg, physicians, supervisors) as likely bullies. These authors were surprised that their findings revealed the patient's family was also a source of bullying. Similarly, we noted that parents were identified as bullies 15% of the time in the secondary school setting, which is a unique facet of WPB, unlike the collegiate setting, in which the AT may not interact with parents. The manifestation of WPB as a result of parental involvement, however, is explainable and even parallel with those findings in the collegiate setting, as today's parents are often defined as “helicopter” parents—individuals who are involved in all aspects of their children's lives, thus advocating and pushing them to succeed.³¹ So, in the case of WPB, it may be that the parent is pushing for the child to participate despite injury. Parents at the secondary school level can play a much greater role in advocating for their children, which is likely the reason for their emergence as a factor facilitating acts of WPB.

Though not statistically significant, we found that more women than men in our study were targets of WPB. The 66% of targets in our study who were women was 8% higher than the national average reported in the 2010 Workplace Bullying Institute National Survey.³² With respect to perpetrators, the Institute³² found that 62% of workplace bullies were men. In our study, significantly more perpetrators were male (71.6%, n = 48) than female (28.4%, n = 19), a value almost 9% higher than the national average. This finding is not surprising, as the sport culture has long been dominated by men,³³ and male coaches continue to be selected over females as head coaches of the most popular female sport teams in the secondary school setting.³⁴ Our female participants discussed this concept of a sport culture that is dominated by males and used the term good ole boys' club to describe their experiences of WPB. Although no reports exist regarding sex discrimination in the athletic training secondary school setting, it has been found in the collegiate setting.³⁵ Thus, ATs working in this setting may encounter workplace acts that mirror acts of either discrimination or bullying—as men continue to maintain a majority of the coaching, leadership, and administration roles.³⁴

Experiences of WPB

Bullying in the workplace has been reported to impair the wellbeing of employees and results in many negative health outcomes³⁶ as well as dissatisfaction with one's work.³⁷ Our participants discussed increased levels of anxiety, depression, and sleep disturbances, all of which are associated with being the target of a bully.³⁸ These physical and psychological problems directly influence a health care provider's ability to render quality care³⁶ and should raise concerns among athletic training professionals and employers alike, despite the low prevalence found in this study.

In addition to increased stress, depression, and sleep disturbances, our participants also described a level of self-doubt creeping into their practice as a result of being bullied. A previous researcher³⁹ showed that targets of WPB commonly reported depreciated self-confidence. MacIntosh⁴⁰ found similar outcomes in her study of rural nurses: targets of bullying described lowered levels of self-confidence and self-esteem that eventually led to feelings of insecurity in their nursing roles. Arguably, self-doubt in the workplace may result in indecision that interferes with the actions necessary for quality patient care and may contribute to poor patient care outcomes. However, poor patient care outcomes did not emerge in our study. In fact, these participants dealt with bullying by refocusing their role on the patients they served.

Participants in our study dealt with bullying in 2 ways, avoidance and role refocusing. Avoidance involved evading the bully, both face to face and virtually (ie, electronically). Avoidance has long been identified as 1 of several coping mechanisms for stress and conflict.^41,42 When a situation is uncontrollable, avoidance may well be an effective approach to reduce stress and increase hope for change.⁴² However, 1 potential cost of avoidance as a conflict-resolution strategy is that it may interfere with an appropriate action that can otherwise affect the threatening situation.⁴² In fact, avoiding interpersonal conflict, though a popular choice among individuals working in organizations, is seldom effective.⁴³

Role refocusing was used by our participants in an attempt to align their efforts with what they believed was most important: interactions with patients and patient care. This finding is consistent with the refocusing that occurs during the organizational socialization process of collegiate ATs.²⁷ Pitney et al²⁷ found that, for those who perceived little organizational support for their athletic training role yet chose to remain in their current position, refocusing on their true reward of being a trusted provider of health care was a way to relieve the stress and strain of the role and maintain their employment. Moreover, the concept of workplace resiliency can provide context for those working in this setting; if they can develop strong communication skills, have an optimistic outlook on life, demonstrate strong coping skills, and have a strong sense of self-worth and understanding of their professional role, they are more likely to succeed and overcome workplace problems such as WPB. Refocusing, much like resiliency, can enable ATs to visualize their value in the workplace and focus on the positive aspects they are able to enjoy. Also, we observed that individuals with more years of experience had lower bullying scores. Perhaps experience buffers bullying attempts in the workplace.

Limitations and Future Directions

Although we had more than 550 survey respondents, the response rate was just under 20%; thus, the results must be interpreted with caution. Future investigators should continue to study a representative sample of ATs in all employment settings. Moreover, although we could compare research in the secondary school and collegiate settings, future authors could include both settings for a true assessment. Another limitation was that a small sample of ATs completed the qualitative portion of the study and, even though the findings are comparable with our previous results in the collegiate setting, they are not generalizable to other contexts. Our data help us gain a better understanding of WPB in the secondary school setting and highlight some differences from the collegiate setting. Future investigators should divide the secondary school setting into the middle school and high school settings, as those findings may differ as well. We have learned who is doing the bullying, but we need to understand more about the specific reasons an AT may be bullied in the workplace. The emotional consequences of bullying may predispose these ATs to burnout; thus, future authors should examine the relationship between these constructs. Finally, we should assess the prevalence and experiences of WPB among ATs in other settings, such as outpatient rehabilitation centers, physician offices, and hospitals, where ATs interact with other professionals; these settings are growing rapidly and offer a host of different expectations and demands. Work is needed to help ATs recognize and effectively manage bullying when it occurs.