Secondary School Athletic Trainers’ Experiences Managing Workplace Organizational-Professional Conflict

Research Design

This study was part of a larger multimethod investigation that examined secondary school ATs’ experiences with OPC centered around medical decision making. The quantitative data portion of the study, which was collected first, was published previously.¹² To explore secondary school ATs’ experiences with OPC from an individual perspective and gain an in-depth understanding into their strategies for managing OPC, we used a phenomenological research design. We selected a phenomenological framework to examine and describe ATs’ experiences with OPC and their medical decision making. The University of Connecticut Institutional Review Board approved this study.

Participants

A total of 16 secondary school ATs participated in follow-up telephone interviews. We recruited our participants from the cross-sectional survey in Phase I of the larger study.¹² At the completion of the survey, we asked respondents about their willingness to participate in a one-on-one follow-up interview. Individuals who were interested in being interviewed served as the participant pool for the qualitative portion of the study. Once we reached data saturation after the 16th interview, we stopped recruiting. Sampling inherently was purposive, as we targeted those working in the secondary school setting. Data saturation was determined by the lead author who completed all 16 interviews and used a constant comparative approach to ensure it was established.^13,14

Our participants represented various employment types, years of experience, and backgrounds regarding athletic training clinical practice. A greater percentage of participants were female (n = 9, 56%) than male (n = 7, 44%). The average age of participants was 43 ± 11 years. At the time of the interview, participants were certified as ATs for an average of 17 ± 9 years, served in their current role at the secondary school for 9 ± 6 years, and worked in the secondary school setting for a total average of 14 ± 9 years. Specifics regarding individual participant demographics, including years of clinical experience and educational background are outlined in Table 1. Employment-specific demographics, such as employment type and status, as well as previous settings in which the participants have worked are outlined in Table 2.

Table 1. Participant Demographics

View Fullscreen

Table 2. Employment-Specific Participant Demographics

View Fullscreen

Interview Guide Development

Using previous research on organizational conflict, we created an interview protocol.^5,7 All 3 members of the research team are certified ATs who also are trained in qualitative methods. Two of the members of the team have provided medical care in the secondary school setting, giving them employment-specific knowledge of the setting. Following the development of the interview guide, an expert in the field with extensive experience in qualitative research and knowledge of OPC reviewed the guide for content, completeness, and presence of any leading questions that included or implied the desired answer. Before data collection, we had the interview protocol piloted with 2 ATs matching our inclusion criteria. Both ATs had been employed in the secondary school setting for 28 years and therefore had significant experience to draw back on when providing feedback related to the content and design of the interview guide. Minimal but important feedback was offered during the piloting process, including the suggestion to add questions pertaining to intrinsic or self-inflicted pressure that ATs may put on themselves and their role. Since changes were made to the interview guide after the pilot process, data from the 2 interviews were not included in the final analysis.

Data Collection Procedures

Using a semistructured format, the lead author conducted all interview sessions to ensure consistency in the protocols. The semistructured nature allowed for a degree of flexibility in the interviews as well as afforded the opportunity to follow-up on topics or experiences that needed clarification or expansion. Moreover, the constant comparative process is best done with the same interviewer, as it allows immersion of the data to occur organically.¹⁴ Interviews were recorded after participants provided consent, with each interview lasting approximately 35 minutes. Each participant was asked a series of demographic items as well as questions pertaining to 2 main areas: (1) the working relationship dynamic that ATs have with coaches, high school administration, athletes, and parents and (2) their experiences with conflict or pressure from these stakeholders. Upon completion of the interview, transcription occurred immediately, and basic member checks were performed in which participants reviewed their transcripts and confirmed accuracy.

Data Analysis

Qualitative data were analyzed using an interpretive phenomenological approach.¹⁵ We chose the analytic procedure to gain a better understanding of the lived experiences of our participants. Upon receiving the transcribed files back from the transcription company, analysis of the qualitative data ensued. The first step in the data analysis process centered around immersion, which involved multiple read-throughs of the transcripts to gain familiarity with the data and get exposed to our participants’ thoughts, perceptions, and first-hand experiences. After immersion, the transcripts were thoroughly read with a critical eye, and initial codes were assigned to chunks of data that related back to the purpose and research questions. The codes were evaluated and grouped together based on similarities in meaning to form overarching categories. The categories were then operationally defined to form themes in the data that represented the experiences of the participants. Overall findings resulting from our study are presented as emergent themes and are supported by relevant direct quotes from participants.

Credibility Procedures

Ensuring trustworthiness in the findings is a crucial step when carrying out a qualitative research agenda. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to establish rigor in the study’s procedures as well as the development of this manuscript.¹⁶ To establish credibility, we used strategies outlined by Creswell, including peer review, basic member checks, and multiple-analyst triangulation.¹⁷ Our peer was selected due to his identified expertise in the field, with experience in qualitative methodology and the topic at hand: conflict in the workplace. The peer was asked to carry out an external audit of the study methodology before data collection, including a thorough review of the interview guide and the data collection procedures. Once data were analyzed, we asked the researcher to review the interpretation of the data.

Member checks, which was the second credibility strategy carried out for this study, verified appropriate and accurate transcription of the audio-recorded interviews. Upon completion of the transcription process, 3 randomly selected interview participants were provided with their respective transcripts and asked, to the best of their knowledge, to confirm the transcript accurately reflected their experiences and the content that was discussed during the telephone interview. As part of the review process, the participants were also given the opportunity to clarify any points of confusion upon reading the transcripts. The final credibility strategy used was multiple-analyst triangulation. Before data collection, the steps for coding were agreed upon to ensure consistency in the coding process. Then 2 research team members independently coded and analyzed the interview transcripts before coming together to compare analyses and reach an agreement regarding the emergent themes of the study.

Effective Communication

The ability to communicate frequently and effectively was a shared sentiment across participants as a key strategy to manage OPC. While participants most frequently talked about communication with coaches, this strategy applied to other stakeholders as well, including parents and other health care professionals (eg, school nurse). Tristan emphasized just that when he said:

I think, in anything I do, parents, coaches, school administrators, communication is key. If you don’t communicate with them and let them know what your abilities are, what you can do, what you can take care of, and what you can’t take care of, then you set yourself up for failure.

Similarly, Margaret discussed the working relationship she has with the school nurse and the role of communication in maintaining that collaborative relationship:

We’re very good about communicating with each other… If she has any problems with any of my athletes or if I have any problems, we communicate back and forth. The kids are allowed to ice during school, but they have to have consent from me and from her, so everybody knows that we’re all on the same page.

Madelyn was transparent about her use of communication and provided specific details on how her approach helped establish rapport with coaches and minimize chances for conflict. She recalled:

So I was definitely going out of my way to sort of establish that [rapport with coaches]. So as far as communicating goes, my thought process was trying to overcommunicate and definitely reach out more often, just double check on them, make sure they didn’t need anything, and really kind of break down and not only educate them but let them know the nitty gritty of what was going on. I was just always in their ear, letting them know my thoughts and what I was doing and where I was at different times, just so they knew everything.

While communication was described by some participants as a proactive strategy, others referenced its role in helping cope with pressure or conflict faced. In speaking about how she has coped with pressure from and conflict with coaches, Veronica said:

I think you have to discuss things… You’ve got to listen to their reasoning, and you have to give your reasoning soundly. If you come up with some good sound reasons why what you are doing is correct, then you know… but you have to listen to what their feelings are… I think a lot of time[s], people all want to get too bullheaded. It’s my way or the highway, and I think if you have a nice 2-way discussion, I think that’s going to be key to coping. Constant communication conquers confusion, and when you can communicate well and everybody involved understands what the other ones are doing, I think you’re going to have less problems.

For our participants, effective communication did not always mean face to face. Given the uniqueness of the secondary school setting, Anthony mentioned the importance of maintaining communication with coaches, even if it is through text or e-mail:

I’m always communicating with coaches via e-mail or texting. I don’t see the coaches every day because there’s so many teams, but I am in constant communication when kids have certain injuries that the coach needs to know. So-and-so has a concussion, and here they are, they’re out, or return[-to-play] protocol. I communicate with them about where I’m going to be covering on a certain day because sometimes we have 4 or 5 events going on at once. They all have my cell phone number. I always ask them to carry their cell phone with them so they can communicate with me directly if something comes up if I’m not at their field or court or whatever.

In general, participants referenced effective communication as a strategy to manage OPC and to resolve conflict when it occurs as opposed to avoiding it. Lauren summarized this nicely when talking about her approach to conflict resolution: “Mainly that my end goal in any conflict is to not walk away, to one, end the conflict, and two, walk away with the sense of mutual respect.” Communication emerged as a way for our participants to manage OPC when it arose in the secondary setting, as it provided a platform for open dialog and conflict resolution, if necessary.

Professional Relationships

As participants discussed their experiences with OPC in the workplace, it became clear that forming professional relationships with the individuals they worked with (eg, coaches, administration, athletes or patients) and building rapport was a key strategy. Brian emphasized the importance of forming relationships when he said:

I always make it a point, [no matter] who they are, where they’re from, what they’re like, that it is truly my job to relate to them. It’s not their job to relate to me. I’m the provider, and I’ve always believed that, no matter who I’m providing care for or who I’m working for, it is truly my job to make sure that I can relate to everybody that I come in contact with, whether it’s a parent or coach, an official or an administrator.

Participants mentioned getting to know stakeholders on a personal level in addition to a professional level was helpful in building characteristics of a strong relationship. Madelyn recalled:

I think just really having a good foundation of getting to know them [stakeholders] on a personal level and also on a professional level and find out the way that they work and the way that they function and then also get some insight into their values, I think that helps because you kind of know what makes people tick and whatnot. So I think understanding people and knowing how they work definitely helps.

Similarly, Paige identified personal connection as a characteristic that makes her relationships with coaches stronger. She said:

Just becoming friends with your coworkers… Oftentimes, even coaches will come to me for a personal injury of some kind… or they bring their children… I mean, that builds a rapport too as well as just helping them with things in their day-to-day jobs… It’s everything outside of the box a little bit, too, that builds that relationship that you truly are there to care for these students.

Though building professional relationships with coworkers was emphasized across the board, participants were transparent about the process taking time. Susan discussed the challenge associated with time as it relates to relationship building in the secondary school setting. She said:

A lot of employees are thrown into a working environment with no real time to get to know each other, and the season starts. Then you have to develop those relationships in and amongst injuries.

Susan referenced this challenge as being temporary, however, since more time with coworkers allowed for the relationship to develop. She continued:

With any given relationship, the longer you have with someone, usually, I think, the more they trust you and they know why you’re there and who you’re there for and what you’re about. So the more interaction you have with them, I think, probably always makes a better, stronger relationship.

Richard also spoke about time being an important factor in building professional relationships. He said:

Over time, the longer you’re at one place, I think that definitely helps with the relationship just because they learn about you and how you run things… Coaches turn over quite a bit, so there’s only a few that have been here longer than I have. So I think that helps when you’re here and then new coaches join. They learn about you from other coaches, and they gain your trust.

Participants often used words like “trust” and “respect” to describe their working relationships with coworkers. Anthony described the relationships he has with the coaches he works with and, in doing so, highlighted the importance of an alignment of values and priorities among professional relationships. He reflected:

I think they [coaches] really respect what I do. I think they understand that I’ve been doing this for a long time… They’re not here to win world championships. They’re here to help kids get better, and they are trying to win titles and things like that, but… they know that what I say is what we have to do. There’s no conflicts.

Professional relationships personalized and humanized the interactions between various stakeholders and ATs which helped manage OPC.

Stakeholder Education

Participants discussed the importance of educating stakeholders, including coaches, parents, and student-athletes, on clinical reasoning and other areas of athletic training practice to manage OPC. In reference to providing justification for decisions made, Veronica mentioned:

I still think it all comes back down to being able to talk to your athletes, to talk to your coaches, talk to your parents… you got to go out and actually discuss with people your reasoning, and often with coaches, I think, if they understand your reasoning, then usually they’re pretty intelligent people. They’ll listen to reasoning, and if they refuse to, then that’s when I fall back on, “I have the degree, and you don’t,” as hard as that sounds sometimes.

Jonathan discussed similar strategies when reflecting on instances in which a coach was pressuring him. To manage these situations, he said:

I now walk coaches through my thought process as well as the thought processes of doctors if I’ve talked with them… so that’s how I approach it, and if I have to, my go-to if there’s ever conflict… is liability, lawsuits, and everything else, and that usually shuts down conversations really quickly.

Beyond justifying medical decisions, participants spoke about the role of stakeholder education in 2 specific areas, 1 of which was professional advocacy. Conversations with stakeholders surrounding professional advocacy often involved discussing the roles, value, and qualifications of ATs. When asked about working relationships with coaches and if some were stronger than others, Emily reflected:

I think the younger ones because I think they’re more familiar with what [ATs] do. I mean, with it being a newer field, some of the older coaches, it just takes more education for them as to what we can do and different things… just explaining to them why we do what we do and why we’re qualified, yeah, just trying to educate them.

Some participants were explicit with where the professional advocacy occurred beyond a one-on-one conversation. Jason said:

I would say some of [the] measures to take would be explaining who you are as an [AT]… when they have Occupation Day or whatever, go in and explain what you do. I think that helps a lot.

Parent meetings were also identified as a forum for educating stakeholders on the AT role to manage OPC. Richard reflected:

Well, with the parents, we have held some athletic parent meetings in the past… I at least try to tell them who I am, what I do, where I’ll be, kind of background so they understand somebody’s there looking after [their] child… I think that helps.

The second area participants mentioned educating stakeholders on was injury prognosis and return-to-play timelines. This was often the case when participants were on the receiving end of pressures from parents, coaches, or student-athletes themselves to return athletes to play before they were medically ready. Gabrielle spoke to her experiences educating parents in this area when she said:

With parents, again, it comes back to education. A lot of my parents don’t work in health care, so they really have no idea when their student-athlete sustains an injury what exactly is going on and what needs to happen. I think, most of the time, I’m really good at educating them on what happened, what needs to happen next, and where to go from there.

When educating coaches on student-athletes’ playing statuses, Susan mentioned the importance of keeping her communications short and to the point. She explained:

I usually just have to talk to them [coaches] before practice starts and explain what’s going on… I just find that what works best is just to tell them what the situation is and walk away, meaning that they don’t want me to give a long, lengthy explanation. They just want to know what their kid can and can’t do… it usually helps them to process. So I feel like that kind of helps.

Susan continued to talk about the role of collaborative decision making and how, when appropriate, that can be a way to manage OPC:

If it’s a situation where it’s not necessarily something that I have to stand completely firm on, then I sometimes say, “Okay, well, let’s make a decision together. What would you like to see them do today?” “Okay, based on their function, yeah, I think they can do that,” and so compromise a little bit.

Participants found that educating stakeholders in a variety of ways was a key strategy for mitigating OPC as well as managing it when it occurs. Education provided collaboration and inclusion for the stakeholders, reducing push back or OPC.

Professional Experience

The last theme that emerged from participants’ experiences with OPC was the idea of professional experience. Participants reflected on their tenure in the profession and spoke about the role experience played in building their overall confidence. The confidence then helped to mitigate OPC and manage it when it occurred. Kevin reflected on how his confidence has evolved over time when he said:

I think I lacked the confidence back then. I had the competency. I had all the school stuff. I had all the taping skills. I had the skill level, but the confidence was lacking, and I think I’ve procured that over the years. As more and more happened, you gain that experience… I just think the more reps of football practice you see or baseball innings or hockey games, it just increases confidence.

Brian also discussed the role experience played in his overall confidence:

I think maybe, early on, there were more questions on whether how I was doing this [was] right or wrong if I had conflict, but I think, at this point in my career, I don’t have any issues there. I know what I’m doing is right. I’ve had a ton of experience with it. Some people might do things a little bit differently than I might, and I’m okay with that. I think I’m okay saying that I know how I’m handling each happening and each situation is probably the best course, and that’s based on a lot of education and experience.

Similarly, Veronica said:

Once in a while, it’ll hit me when I’m just like, “Could I do that eval[uation] over again?” But it’s not as often as it was when you first start. When you first start, I think you really are nervous, but the more years you get in, the more confident you become with it.

When asked directly about strategies used to mitigate pressure and conflict in the workplace, Gabrielle reflected on the role of experience:

I would say experience, too. The longer that you’re in it, the more opportunity that you’re going to have to run into those situations [conflict or pressure] and be able to look back and reflect back on how you handled it, and again, if you could have handled it differently, how would you? Obviously, in my first 2 years when I was a graduate assistant at a small high school still getting my master’s degree, I think back to situations with the coaches and stuff there and how I was definitely more timid than I am now. I wouldn’t say that I let anybody push me over, but I definitely have grown from those first experiences that I did have.

While experiences with OPC differed from one participant to the next, the role of stakeholder education, effective communication, professional relationships, and professional experience in managing conflict in the workplace was a shared sentiment across participants.

Limitations and Future Research

Our qualitative study contains responses from 16 ATs working at the secondary school setting. Although the approach allowed depth to our results, a common limitation of qualitative research is generalizability. Organizational-professional conflict occurs at the organizational level, and different organizations may have different challenges for clinicians to navigate. Future investigators should attempt to study OPC within different employment settings and models from a qualitative perspective. Additionally, we believe that future researchers should explore how programs are preparing students to manage conflicts in the workplace, as they are likely to occur.