Experiences of Work-Life Conflict for the Athletic Trainer Employed Outside the National Collegiate Athletic Association Division I Clinical Setting

Abstract

Context

The intercollegiate setting receives much of the scholarly attention related to work-life conflict (WLC). However research has been focused on the National Collegiate Athletic Association Division I setting. Multiple factors can lead to WLC for the athletic trainer (AT), including hours, travel, and lack of flexibility in work schedules.

Objective

To investigate the experiences of WLC among ATs working in the non-Division I collegiate setting and to identify factors that contribute to fulfillment of work-life balance in this setting.

Design

Qualitative study.

Setting

Institutions in the National Collegiate Athletic Association Divisions II and III, the National Association of Intercollegiate Athletics, and the National Junior College Athletic Association.

Patients or Other Participants

A total of 244 ATs (128 women, 114 men; age = 37.5 ± 13.3 years, experience = 14 ± 12 years) completed phase I. Thirteen participants (8 women, 5 men; age = 38 ± 13 years, experience = 13.1 ± 11.4 years) completed phase II.

Data Collection and Analysis

For phase I, participants completed a previously validated and reliable (Cronbach α > .90) Web-based survey measuring their levels of WLC and work-family conflict (WFC). This phase included 2 WFC scales defining family; scale 1 defined family as having a partner or spouse with or without children, and scale 2 defined family as those individuals, including parents, siblings, grandparents, and any other close relatives, involved in one's life. Phase II consisted of an interview. Qualitative data were evaluated using content analysis. Data source and multiple-analyst triangulation secured credibility.

Results

The WFC scores were 26.33 ± 7.37 for scale 1 and 20.46 ± 10.14 for scale 2, indicating a moderate level of WFC for scale 1 and a low level of WFC for scale 2. Qualitative analyses revealed that organizational dimensions, such as job demands and staffing issues, can negatively affect WLC, whereas a combination of organizational and personal dimensions can positively affect WLC.

Conclusions

Overload continues to be a prevalent factor in negatively influencing WLC and WFC. Supervisor and peer support, personal networks, and time away from the role positively influenced work-life balance and WFC. Athletic trainers are encouraged to support one another in the workplace, especially when providing flexibility in scheduling.

Key Points

• Organizational factors influenced work-life conflict and work-life balance (WLB) for the athletic trainer.

• Overload was a prevalent negative influence on WLB.

• Supervisor and peer support, personal networks, and time away from the role positively influenced WLB.

• Athletic trainers should support each other in the workplace, and supervisors should encourage and support the concept of job sharing.

Work-family balance often is discussed as the extent to which an individual is equally involved in and equally satisfied with his or her work and personal and family roles.¹ Conceptually, the work and family interface is viewed as one that is either in balance or in conflict. Thus, the terms work-family balance and work-family conflict (WFC) reflect the perspective that is viewed as either negative (conflict) or positive (balance). The concept of WFC or work-life conflict (WLC) has become a focus of attention within athletic training, particularly as it has been linked directly to perceptions of job satisfaction and retention in the field.^2–5 Initially, the concept of WFC was investigated by Mazerolle et al,^2,3 but after finding no differences among demographic characteristics, such as sex, age, and marital status, they suggested WLC as a more appropriate term, because WFC suggests the need to have a spouse or children to experience a conflict. Therefore, when discussing conflicts that arise from balancing multiple roles, the term WLC is used, whereas when the domains are viewed in balance, the term work-life balance (WLB) is used.

The growing body of literature has highlighted the idea that hours worked, travel, work-schedule flexibility, and coaches' expectations and demands can contribute to WLC for the athletic trainer (AT).^2,3,6,7 The experiences of WLC for the AT are comparable with others employed within the sports industry, including coaches^8–10 and sports information personnel.¹¹ The underlying cause of WLC appears to stem from the organizational structure of the work setting, including work schedules, hours worked, and job demands.⁸ Work-schedule flexibility and hours worked appear to be the biggest culprits in creating WLC for the AT,^2,3,6,12 especially for ATs employed in the collegiate setting.^2,12 However, these factors appear to be synonymous for anyone working in the sport industry, as long hours are expected, are required, and have become a part of the organizational culture.^9,10 Outside of the collegiate setting, sources of conflict may vary due to different job expectations.

Differences have been reported within the various employment settings in athletic training, particularly for sources of conflict.⁷ For example, ATs employed in the rehabilitation or clinical setting have more structured work schedules and report fewer concerns with WLC than ATs employed in more traditional settings that require working 40 or more hours each week and frequent travel. Whereas we have a strong understanding of the National Collegiate Athletic Association (NCAA) Division I setting, we have a limited understanding of the experiences of ATs working outside the NCAA Division I collegiate setting (non-Division I setting), including NCAA Divisions II and III, National Association of Intercollegiate Athletics, and National Junior College Athletic Association institutions. Given that clinical setting can influence the experience or source of conflict for the AT, we need to fully understand the collegiate setting, as demands and role expectations can vary. According to Brumels and Beach,¹³ the role of the AT in the collegiate setting can be demanding and complex due to travel; obligations to multiple teams; and competing roles, such as teaching, supervision of students, and other administrative duties required of the position. When coupled with the high expectations and needs of coaches and athletes, the potential for overload and conflict with outside responsibilities is created.

As mentioned, researchers have noted differences in occupational setting within athletic training related to sources of WLC or WFC, but most of the literature on this concept in the collegiate setting has stemmed from the Division I setting. The NCAA suggested that differences exist among collegiate programs specifically related to finances and academics.¹⁴ The investments made within each program can influence expectations of all members of the athletics department, including ATs. Differences in atmosphere and priorities can affect the workplace culture, which is strongly related to WLC and WFC for the AT.¹⁵ Thus, despite the strong knowledge base about the Division I setting, more information is necessary regarding the WLC experiences of ATs who work outside the Division I setting, as resources and expectations likely are different. Therefore, the purpose of our study was twofold. First, we sought to explore WLC among ATs working in the non-Division I setting and to identify factors that contribute to fulfillment of WLB in this setting. Second, we wanted to gain insight and understanding about which factors mitigate WLC outside the Division I setting. The following questions guided our investigation: (1) To what extent do ATs in the non-Division I setting perceive WLC? (2) Is there a connection between the level of WLC and various demographic variables (eg, sex, marital status, family-unit size)? (3) Does the work environment outside Division I influence the occurrence of WLC? (4) What factors are perceived to reduce WLC?

METHODS

Research Design

A sequential, mixed-methods research design was used to examine WLC within the athletic training profession with ATs employed in a collegiate setting that was not classified as Division I (ie, Division II, III, National Association of Intercollegiate Athletics, or National Junior College Athletic Association intercollegiate athletics). The design is well scripted in the literature and, as described by Creswell,¹⁶ includes collecting and analyzing quantitative data first and qualitative data second.

We selected this design because, based on our research questions, we needed both quantitative data (questions 1 and 2) and qualitative data (questions 3 and 4). Moreover, we sought a comprehensive account of WLC and wanted to complement our data and enhance the utility of our findings, all of which are purported purposes of mixed-methods design.¹⁷ This method has been used in athletic training research on WFC by Pitney et al⁶ and allows us to gain a holistic impression of the experiences of the person. The advantage to this explanatory method is to gain a straightforward and more quantifiable understanding of WLC in athletic training in 1 phase, while having the chance to explore the topic more in depth through another phase. In our study, we used a Web-based survey instrument (phase I) and one-on-one phone interviews (phase II).

Participants

A total of 244 ATs completed phase I of the study. The National Athletic Trainers' Association (NATA) Member Services Department generated a random list of ATs employed outside the Division I clinical setting. The NATA provided us with a list of 1250 e-mail addresses; e-mails to 4 of these were undeliverable. From the 1246 delivered e-mail invitations, 269 (21.6%) recipients responded. Twenty-five were removed from the database because they worked at the Division I level, leaving 244 (128 [52.5%] women, 114 [46.7%] men, 2 [0.8%] undisclosed sex; age = 37.5 ± 13.3, experience = 14 ± 12 years) in our final sample. A total of 179 (73.4%) had obtained a master's degree. Additional demographic information for our participants in phase I can be found in Table 1.

Table 1.

Participant Demographic Data for Phase I (N = 244)

Demographic	No.	%a
Sex
Female	128	52.5
Male	114	46.7
Undisclosed	2	0.8
Highest degree obtained
Bachelor's	52	21.3
Master's	179	73.4
Doctorate	12	4.9
Not specified	1	0.4
Family situation
Married or partnered	137	56.1
Single, never married, or never partnered	76	31.1
Living with significant other	21	8.6
Divorced	6	2.5
Not specified	4	1.6
Athletic level
National Collegiate Athletic Association Division II	73	29.9
National Collegiate Athletic Association Division III	104	42.6
National Association of Intercollegiate Athletics	23	9.4
National Junior College Athletic Association	36	14.8
Other	8	3.3

^aPercentages are rounded.

Thirteen (8 [61.5%] women, 5 [38.5%] men; age = 38 ± 13 years, experience = 13.1 ± 11.4 years) participants volunteered to complete phase II of the study. Eight individuals had volunteered to complete phase II after completing the online questionnaire in phase I by providing contact information at the end of the questionnaire, and we purposefully recruited an additional 5 ATs to reach data saturation. All 13 participants were recruited purposefully via e-mail,¹⁵ as they met our inclusion criteria of being employed full time outside a Division I setting. Six (46.2%) of these participants were single, and 7 (53.8%) were married or partnered. Participant demographic data are provided in Table 2.

Table 2.

Individual Participant Pseudonyms and Demographics for Phase II

Pseudonym	Sex	Age, y	Marital Status	Employment Division	Experience, y	Average work, h/wk
Kristen	Female	28	Single	NCAA Division II	5	45
Rebecca	Female	29	Single	NCAA Division II	6	50
Janelle	Female	54	Married	NCAA Division II	27	60
John	Male	48	Married	NCAA Division II	25	50
Andrew	Male	25	Single	NCAA Division III	3	65
Kim	Female	28	Partnered	NCAA Division III	6	55
Cathy	Female	24	Single	NCAA Division III	2	50
Jules	Female	45	Married	NCAA Division III	20	60
Deborah	Female	48	Married	NCAA Division III	6	60
Oliver	Male	54	Married	NCAA Division III	29	50
Cameron	Male	29	Single	National Association of Intercollegiate Athletics	5	55
Adrian	Male	58	Married	National Association of Intercollegiate Athletics	36	60
Sarah	Female	25	Single	National Junior College Athletic Association	4	70

Abbreviation: NCAA, National Collegiate Athletic Association.

Procedures

Phase I Data Collection

We used a validated Web-based survey instrument consisting of 2 sections: (1) demographics and (2) 2 self-report scales measuring perceived level of WFC based on current family status.⁶ The first section contained 15 items pertaining to general demographic characteristics, such as age, sex, years of experience, hours worked, and marital status. After completing the demographics section, participants were instructed to respond to two 5-item scales on WFC. To date, the WFC scale is 1 of only a few measures used to assess conflict between personal and professional roles, and this is why we included it. The WFC statements are included in Table 3. The first WFC scale defined family as having a partner or spouse with or without children; the second WFC scale defined family as close relatives, including parents, siblings, and grandparents, involved in one's life. Participants could answer 1 scale or both scales, depending on their family situations. This format was used in WFC studies by Mazerolle et al^2,3 and Pitney et al⁶ to recognize the many family roles an AT can assume (eg, parent, spouse, child). Moreover, the use of both scales presents an assessment of WLC and WFC in athletic training.

Table 3.

Work-Family Conflict Scales Measure of Central Tendency^a

Statement	Scale 1				Scale 2
	n	Mean ± SD	Median	Interquartile Range	n	Mean ± SD	Median	Interquartile Range
The demands of my work interfere with my personal and family life.	236	5.51 ± 1.51	6	2	181	4.11 ± 2.18	4	4
The amount of time my job requires makes it difficult to fulfill my family responsibilities.	233	4.97 ± 1.61	5	2	181	4.12 ± 2.00	4	4
Things I want to do at home do not get done because of the demands of my job.	236	5.33 ± 1.63	6	3	181	4.09 ± 2.17	4	4
Due to work-related duties, I have to make changes to my plans for family activities or miss out on family-related activities.	235	5.75 ± 1.56	6	2	181	3.99 ± 2.27	4	4
There is a conflict between my job and commitment to those responsibilities and the responsibilities I have to my family.	236	4.96 ± 1.69	5	2	181	4.15 ± 2.04	4	4

^aScale 1 defined family as having a partner or spouse with or without children; scale 2 defined family as close relatives, including parents, siblings, and grandparents, involved in one's life. Individuals could answer either or both scales depending on their current family situations. Each instrument was a 7-point Likert scale with 1 = strongly disagree through 7 = strongly agree. Adapted with permission from Pitney WA, Mazerolle SM, Pagnotta KD. Work-family conflict among athletic trainers in the secondary school setting. J Athl Train. 2011;46(2):185–193.

Netemeyer et al¹⁸ first substantiated the WFC scales. Each scale was scored on a 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree). In athletic training, the scale has been used by other researchers who have examined WFC and has revealed strong reliability, with an overall Cronbach α of .89. Pitney et al⁶ examined the reliability of the 2 scales, with a Cronbach α of .95 for scale 1 and .94 for scale 2. With 5 items, the possible score ranges from 5 to 35, with a higher score indicating a higher WFC level (5 to 15 = low, 15.1 to 25 = moderate, and >25 = high). The total time to complete phase I was approximately 10 minutes. For our study, the reliability was high: Cronbach α levels were .94 for scale 1 and .97 for scale 2.

Phase II Data Collection

The phase II semistructured interview guide has been used by Pitney et al⁶ and reflected our purpose and research agenda. All questions were open ended and designed to spark discussion between the interviewer and participant. Before implementation, a peer (W.A.P.) reviewed the interview guide to ensure interpretability and flow to the interview sessions. All interview sessions, which were conducted by 1 researcher (W.A.P.), were recorded digitally and transcribed verbatim by an independent transcription company to help reduce bias. On average, each interview session lasted approximately 40 minutes. During the semistructured interview, participants were instructed to discuss their experiences with WLB, facets of their positions that contribute to or hinder finding a balance, and recommendations for finding WLB.

Data Analysis

We used measures of central tendency to analyze participant demographics. The level of perceived WFC was examined with the summed response to the 5 WFC items in each scale to determine the extent of WFC that permeated the work-home interface.⁶

To examine the differences between the independent variables (work schedule, sex, flexible work schedule) and the 2 dependent variables (WFC scores from each inventory), we originally planned to use parametric test procedures for our analyses; however, our data were not normally distributed, as indicated by the Shapiro-Wilk test of normality (P < .001). Therefore, we used a Kruskal-Wallis H test. For the post hoc analysis of the scale 1 data, we conducted separate Mann-Whitney U tests with a Bonferroni correction (P ≤ .02) to analyze each pair. We used a Pearson product moment correlation to examine the relationship between WFC level and (1) average work hours per week and (2) total number of athletic training staff in work context. We used a regression analysis to determine whether years of experience predicted WFC scores. The α level was set a priori at .05 for all analyses. All quantitative data were analyzed using SPSS statistical software (version 20.0; IBM Corporation, Armonk, NY).

Qualitative data were examined using a basic inductive content analysis described by Merriam.¹⁹ We conducted an initial evaluation of the textual data and identified and tagged the main concepts with conceptual labels. On subsequent readings, the conceptual labels were grouped and assigned new labels as the emergent themes were identified. Two strategies beyond the use of data-source triangulation were selected to establish credibility of the findings, including a peer review and multiple-analyst triangulation. Data-source triangulation was established by using a mixed-methods study design. After completing the data-analysis process, 2 authors (S.M.M., C.M.E.) compared their findings by sharing their schematic codes, supporting textual data, and operational definitions of the emerging themes. The 2 authors negotiated the presentation of the data and were in complete agreement before sharing the findings with a peer (W.A.P.). He helped verify the final coding of the data. The peer has educational training in qualitative methods and analyses and previous experience as a collegiate AT.

RESULTS

Phase 1 Quantitative Findings

The calculated mean WFC scores were 26.33 ± 7.37 (median = 28.0) for scale 1 and 20.46 ± 10.14 (median = 20.0) for scale 2, indicating a moderate level of WFC for scale 1 and low level of WFC for scale 2.

For scale 1, the mean WFC scores were slightly higher (27.77 ± 6.80) for women than men (26.04 ± 7.66). For scale 2, WFC scores for women (20.81 ± 10.20) and men (20.44 ± 10.17) were comparable. Our Kruskal-Wallis H test revealed no difference in the perceived level of WFC between men and women for either scale 1 (χ²₁ = 3.17, P = .08) or scale 2 (χ²₁ = 0.8, P = .78). The mean, standard deviation, median, and interquartile range for each item on the scales are provided in Table 3.

We found no difference in the scale 1 (χ²₄ = 6.60, P = .16) or scale 2 (χ²₃ = 6.56, P = .09) WFC scores among the various family situation variables (single, never married or partnered, living with significant other, married or partnered, or divorced). The Kruskal-Wallis H test used to examine scheduling flexibility revealed a difference in scale 1 WFC scores (χ²₂ = 35.18, P < .001) but no difference in scale 2 WFC scores (χ²₂ = 0.286, P = .87). Our post hoc analysis of the scale 1 data revealed that ATs who always had scheduling flexibility had lower WFC scores (20.29 ± 6.96) than those who sometimes had scheduling flexibility (25.81 ± 7.25) and those who never had scheduling flexibility (30.98 ± 5.21; Table 4). We also observed a relationship between the average hours worked per week and WFC scores on scale 1 (r = 0.312, P < .001), indicating that, as work hours per week increased, the level of WFC reported increased. We found no correlations for scale 2 and hours worked per week. Participants reported averaging 54.4 ± 12.6 hours of work per week. A regression analysis was used to test if years as a Board of Certification-certified AT predicted WFC scores on each scale. The results indicated that years of experience as a Board of Certification-certified AT did not predict WFC score for scale 1 (R² = −0.004, F_1,236 = .002, P = .96) but was a predictor for scale 2 (R² = 0.045, F_1,236 = 12.21, P = .001).

Table 4.

Work-Family Conflict Scores Among 3 Scheduling Flexibility Groups

Variable	Scheduling Flexibility Group						Statistical Analysis
	1: Always Have Scheduling Flexibility		2: Sometimes Have Scheduling Flexibility		3: Never Have Scheduling Flexibility		Kruskal- Wallis Score	Comparison Group	Mann- Whitney U Score	Post Hoc P Value
	No.	Mean ± SD	No.	Mean ± SD	No.	Mean ± SD
Work-family conflict scale 1	17	20.29 ± 6.96	176	25.81 ± 7.25	42	30.98 ± 5.21	χ22 = 35.18	1 Versus 2	826.5	.002a
							P < .001	1 Versus 3	69.0	<.001a
								2 Versus 3	1923.0	<.001a
Work-family conflict scale 2	12	20.25 ± 8.77	140	20.59 ± 9.71	27	19.63 ± 10.13	χ22 = 0.29	1 Versus 2	838.0	.99
							P = .87	1 Versus 3	142.0	.54
								2 Versus 3	1778.5	.63

^aIndicates difference (P < .05).

Phase II Quantitative Findings

Our analyses revealed that organizational dimensions, such as job demands and staffing issues, can negatively affect WLB, whereas a combination of organizational and personal dimensions can positively affect WLB (Figures 1 and 2). In the subsequent section, we provide a detailed description of each theme with supporting data. The data presented are directly from participant interviews, and pseudonyms are used throughout.

Figure 1.

Organizational dimensions negatively influencing work-life balance.

Figure 2.

Factors positively affecting work-life balance.

Negative Effects

Through our analysis, we observed that the demands on the AT outside the Division I setting can lead to WLC. The organizational dimensions were linked to the role of the AT and the uniqueness of the setting, such as resources. We present each of those factors.

Organizational Dimensions

The job demands of the AT outside the Division I setting, as well as the limited number of full-time employees available to provide medical coverage to the athletes, summarize the organizational dimensions theme that creates WLC. The job demands in the non-Division I setting included the number of hours worked, days worked, and number of athletes requiring medical care. Cameron summarized the organizational dimensions that can affect the AT in this setting and result in WLC:

I think it's directly related to family time. Most NAIA [National Association of Intercollegiate Athletics] schools, they only hire 2–3 full-time ATs to provide coverage for all the sports teams, and that makes it really tough. Because we've got to be there for every single practice, every single game, we don't have our own dedicated sport to work with, so it makes the hours a little bit more . . . And we don't really have that off-season that a lot of other ATs get when their team is in the off-season, so I would say that's the major thing. The work load as well . . . I know every AT has large workloads during their in-season, but essentially we're in-season all the time.

Deborah shared similar concerns about the collegiate setting:

When my son was a senior in high school, I had a senior, a sophomore, and an eighth grader. All their spring breaks lined up together, of course; however, I didn't get spring break because I was at the collegiate setting. My family would go on vacation, and I would not be able to do so because, being at the college setting, you had to cover baseball, lacrosse in the spring. Of course, those sports played during spring break, and being understaffed, we just couldn't cover that much, and to have me go and take a week and be with my family [wasn't feasible]. So and frankly, that happens every year. I don't think my family and I have taken a vacation together for 4 years, other than the summer when I've got the entire summer off.

Hours Worked

Athletic trainers outside the Division I setting reported working 40 or more hours each week, which was a reason they believed work affected the ability to achieve WLB. Andrew, employed at the Division III level, chuckled after being asked about his WLB and explained:

It is very tough [at times to find a balance] because, in the football season, I am covering practice at 6:00 am. That means I am getting to work at 4:30 am to get the guys ready for practice. So, I am working until 3:00 in the afternoon, and after all that, I just want to sleep. During football, the only time for personal time is after games on Saturdays. In the winter, I may work less, only 9-hour days about 6 days a week. Those hours, though, are more second shift, so still hard to have a normal social life. It is hard enough, at times, to find the time to go get the laundry done or go grocery shopping.

John, a Division II AT, mentioned hours worked as problematic at times, particularly when trying to meet the demands of parenthood and other outside activities. He commented:

It is always a challenge trying to balance the work load and hours with the kids' events, even as they get older, and trying to get time off. I think it's still a little work heavy as compared to other occupations. At [our school], we have a lot of sports to cover. I have football, so it is more time consuming, but I do not work more than 50 to 55 hours per week.

Hours worked precipitated experiences of imbalance, as time available outside of the workplace was limited. Another participant, who had experience working at the Division I level identified the hours as problematic despite not traveling, as required in her other position. Jules stated, “The hours . . . you know [are an issue]. Except for the times over the breaks, when we have only a few times, I am still working 60 to 65 hours per week.”

Days Worked

Working 6 to 7 days per week with limited time off was mentioned as a factor pertaining to WFC. One participant in the Division III setting described her situation as “24/7.” She noted: “I am pretty much working 7 days a week, so I miss family functions, as well as functions with my friends. I miss everything. I mean, Saturdays are 14-hour days, and so it is really difficult right now.”

Taking days off to “have fun” or attend family or social outings was mentioned as difficult to do as an AT. Another AT employed at the Division II setting said, “I think there is [are] always going to be issues with being an AT. You are busy all the time, and it is hard to just take a day off when there is some fun activity going on.” When discussing coaches, Adrian shared: “None of them [coaches] think about support staff. Whether it's athletic training or media relations or ticket takers or anybody else, they don't think about it. They just go ahead and make their own schedule, and all of a sudden, you've got these days that are 12 hours long.”

Work Overload

Unlike the Division I setting, where an AT may be assigned to an individual team, many ATs working outside the Division I setting provide general medical coverage to all athletes within the athletics department. Oliver explained his current workload: “My staff includes myself and 1 part-time assistant. We have 8 teams [which we provide medical coverage to] with over 120 student-athletes (between the teams).” Andrew felt similarly overloaded in providing medical coverage to a large number of athletes:

Here at [my school], we have close to 450 student-athletes, and there are only 4 of us [to do this]. On top of that, we have overlap that begins to happen [when] hockey season starts. So the hours start to become unmanageable [at] that point. I am responsible for over 150 student-athletes, which is a pretty daunting task if you sit down and think about it. It can get pretty overwhelming on top of providing [medical] care and practices and then doing the appropriate paperwork; it becomes a lot [to balance].

As Andrew expressed, the effect of a high athlete-to-AT ratio is apparent. Moreover, the limited number of full-time staff contributed to problems with role overload, as illustrated in the aforementioned statements. When describing the workplace environment, the ATs indirectly discussed limited personnel resources as an underlying cause of imbalance through role overload. John noted a direct improvement of his WLB due to the addition of a third staff member, indicating that staff size can affect WLB, especially when it is not adequate to meet the time demands: “[My balance] absolutely has improved. What that actually did was it allowed me [the time] to do the things I want to do rather than the things I have to do.” Staff size was small at many of the schools employing our participants, and coupled with the provision of medical coverage to a large number of athletes, role overload was likely, as described by our participants.

Positive Effects

We found that ATs identified both organizational and personal dimensions to attaining a balance between their personal and professional roles. We discuss the specific ways to find WLB.

Organizational Dimensions

Two specific organizational-dimension factors helped ATs employed outside the Division I setting find a balance between their work and domestic and personal roles (Figure 2).

Supervisor and Colleague Support

Relationships with supervisors, particularly between the head AT and coworkers, were identified as WLB facilitators for our group of ATs. When making a recommendation to future ATs about achieving WLB, 1 participant observed, “Develop a really good relationship with your supervisor. Whoever gives you time off, you know, it is a matter of having good communication [with them].” The importance of the supervisor recognizing work overload and facilitating time away was identified by an AT:

My boss is really, really good about trying to get us time off if we're being really overworked. You know, if we've been working . . . maybe 4 days into the week and we're already up to 40 hours, if there's an opportunity, he will send us home. So he does a really good job of trying to get us that time off if he can. He can't always do it just because of scheduling, and that's fine, but . . . he does a really good job, and our administration supports him fully in what he's doing. So, you know, if he wants to let us have some time off, then they're not going to say anything about it.

Supervisor support also was described when an administrator provided autonomy over work scheduling and did not micromanage. While describing his relationship with his supervisor, an AT said:

My boss is pretty good [when it comes to balancing]. He does not micromanage us. I think I am at an advantage as well because my boss's wife is an AT. So it gives him a better understanding of what is expected of my job and the hours I work. He [my boss] is also a very family-oriented person, so there are other members of our department who have young children, and they can come in late or do things, when necessary, or if when they get sick [take care of them]. So he is great to work with because he does have that understanding from his wife and family perspective.

This statement illustrates the benefit of a supportive administrator, either head AT or athletic director, who can help facilitate WLB by being flexible and providing independence over work scheduling. Jules illustrated the concept of supervisor understanding, particularly from the athletic administrator:

Our athletic director is a PT-ATC [physical therapist-certified athletic trainer], so I am in a unique situation because he really gets it. He supports us in any way. He is making sure that the coaches are communicating well. He is trying to get the coaches to understand we are here to provide a service, and that in order to do so, we need schedules ahead of time. He was an AT, so he has lived it; he knows the hours that go with providing medical care, so he is not expecting us to work 35 hours a week, but he is not expecting us to be here when we don't need to be. So that is a big positive.

Our participants also mentioned having collegial support as helpful in creating WLB. A participant stated, “We [our staff] have a good understanding that you need some time. My coworkers are really good at covering for one another when we need some time away.” Another AT described teamwork or job sharing as a means of allowing flexibility or time off:

I think we are all pretty close, so if someone needs a day off, we can switch. So I had men's basketball this year, and the person who had women's basketball would cover my sports for the weekend, and then I would cover hers for the following weekend.

Another participant described the appeal of her current work situation and its simplification in finding WLB: “Our staff is like family. We emphasize not missing out on weddings and birthdays and things like that. There is a lot of flexibility in making sure we have a social life and balancing our work and hours.”

She further communicated the importance of her supervisor and his support of flexibility and finding balance:

Understanding also comes from my supervisor. There is a huge emphasis on family and making sure you are not missing things. Instead of micromanaging, we are allowed to make our own hours. As long as practices and games are covered, my boss understands I may not hold traditional 9-to-5 hours. I am able to have down time because of this mentality, and since I don't always have my weekends, I can get things done like going to the bank, etc, during the week.

Contract Length

Contract length was discussed as helpful in creating WLB. Specifically, ATs who did not have 12-month contracts believed that the demands of the setting were more manageable because they were temporary. For example, Cathy discussed her reason for accepting a position: “[My job] is a 9-month contract, which has its benefits and downsides, but I find my balance because I have 3 months off completely, and you know, I guess I still have to go in and do a couple of things, but it's been helpful.”

When reflecting on how WLB had improved over time, another AT named contract length as a direct contributor:

I am on an 11-month contract, not a 12. So with that said, they [my supervisor] ask what month you want to take off, and I know many of my colleagues take December, but I chose to take June off. It worked out in so many ways, you know, as you can figure, when my kids were younger, they were getting out of school, getting ready to start summer vacation. So that was our vacation month. It really just enhanced my personal life.

As described by our participants, contract length provided time off, which was planned and, in some cases, selected by the AT.

Personal Dimensions

Our participants identified support networks outside the workplace as helpful in creating WLB while working as ATs in the collegiate setting. They cited spousal and family support as most helpful. Jules identified her husband as her support, describing him as someone who could help manage parenting and childcare and someone who understands her role as an AT:

He really gets it. He's never questioned me having to be at work at 6:00 am and having to be responsible for drop-off [at childcare for our son] or having to get him ready for school and all that “getting ready” entails. There is no stress on that end. You know, if I am covering a baseball game on a Monday night, he [my husband] knows that he has to pick up our son.

Jules also touched on the importance of a network of support:

Fortunately, I also have my brother, my son's uncle, who is amazing. So, whenever there may be an issue, he can and will help out. My workplace also understands when my son needs to be here, as long as I don't abuse it. So, there's been times when I have picked him up early from school and brought him to work and continued on with my responsibilities without any issues.

Similar responses were recorded by other participants about the effect of a spouse's or family member's support and help on WLB, particularly with being flexible and understanding. Kim shared:

My fiancé is a huge help in keeping balance, especially when things get stressful. She is great. She understands being at the Division III level, the demands associated with the student-athletes and their schedules. She is so understanding, as not everyone gets our wacky or crazy work schedules.

Sharing household duties was discussed by many ATs who were married and married with children, but ATs who were single also highlighted the importance of having a roommate, someone who could be responsible for some of the household duties that can be difficult to manage due to a demanding work schedule. Rebecca noted: “I have a great roommate, and we are very good at working together and doing what needs to be done. I feel like we have an even relationship. I think it is a good, respectful relationship. We are supportive and get those household chores done without a problem.”

In some cases, a roommate provided a soundboard or a support network, as Kristen stated: “I live with a coach. So, she is a nice sounding board when things are not going well and you need to go home and vent.”

Along with support networks, the importance of taking time away from the role of AT was discussed as necessary in creating WLB. Our participants recognized that the field is demanding, complex, and challenging, but understanding one's limits and finding the time to put yourself first were discussed as recommendations for finding balance. One of our participants said, “Every AT needs to know their limits, and it's okay to say no. Work hard, but sometimes you need time off and that sometimes you just need that time off to get rejuvenated and reenergized.” Similar comments were made by others, including the following:

My recommendation is to make sure you take advantage of your free time. So if there is a day off in the summer, take the time to get home to see friends/family or something like that. Just try to make up for the time over the school year that you don't have the time to do things like that.

DISCUSSION

To date, the literature has focused primarily on the Division I setting, as researchers⁹ have speculated that the atmosphere is demanding of its employees. Strong evidence indicates that this setting does stimulate experiences of burnout,^7,20,21 job dissatisfaction,^2,3 and WLC.^3,22 Whereas evidence has shown the rigors of working in the Division I setting, limited literature is available regarding the experiences of the AT working within the other levels of collegiate athletics. Gaining this perspective is necessary, as the role of the AT is complex and may vary based on practice setting. Although occupational setting differences have not been investigated thoroughly, we speculated that experiences may vary due to resources, staffing, and job requirements within these different collegiate levels. Our purpose, therefore, was to examine the experiences of WLC and WLB for the AT outside the Division I setting.

Our quantitative findings were comparable with those of Mazerolle et al² and illustrated that ATs experience conflict when working in the collegiate setting, regardless of the competitive level. Moreover, as investigators^3,22 have suggested, men and women are equally susceptible to WLC. In support of existing literature from the secondary school setting,⁶ we observed that ATs who worked more hours per week and had less flexibility or control over their work schedules were at greater risk for WLC. Research²³ outside of athletic training has implied that one's family situation can mediate the experiences of conflict, with ATs who are married or married with children experiencing more conflict. In fact, the Center for American Progress and the University of California Hastings College of the Law revealed that about 90% of US mothers and 95% of US fathers have reported WFC.²⁴ However, until our study, investigators^3,6,22 studying athletic training have suggested that WFC was not influenced by family situation or marital status. A unique contributor to our understanding of WLC and WLB in athletic training was the length of an AT's contract. Our phase II participants identified a shorter contract (<12 months) as allowing them to find WLB because they could refocus and spend time away from athletic training. In previous reports, Division I ATs reported having 12-month contracts.²

Negative Factors Affecting WLB

Hours worked, work schedule, and work overload, all of which are organizational factors described in the Dixon and Bruening⁸ WFC model, were identified as facilitators of WLC. These factors are not unique to the collegiate setting. Mazerolle et al²² observed that hours worked were often the primary source of WLC, and a normal workweek included 50 or more hours, as noted in our sample. Working excessive hours has become institutionalized within collegiate athletics, as working more appears to be the “normal” and “accepted” practice for ATs who succeed and perform their roles well in the setting. Bruening and Dixon²⁵ noted this concept when exploring the work and family interface among collegiate coaches, as the pressures to succeed and win at all costs permeate all aspects of collegiate athletics. Whereas our participants reported a lower number of hours worked per week (56 h/wk) than those in the Division I setting (64 h/wk),²² this total is much more than the hours reported for the standard workweek of most Americans.²⁶ Standard working hours as established by labor laws and legislation are 40 per week, but the US Labor Department²⁷ estimated that most working Americans log approximately 33 hours per week. Health care professionals, however, often do not work this average workweek. Chin²⁸ reported that many physicians log 18-hour days and workweeks of 100 or more hours, a norm that is changing slowly within the organizational culture and the recognition of the effect it can have on patient care. Despite the push for changes, health care professionals, including ATs, physicians, and nurses, still amass long workweeks due to the unique challenges of patient care and the administrative duties associated with health care. For athletic training specifically, addressing the debate about the appropriate distribution of medical services may need to become a central focus. As Laursen²⁹ suggested, it may be time to move athletic training services to a medical model in which administrative oversight is controlled by medical professionals and not by athletic administrators and coaches who lack the necessary medical knowledge. A shift to a medical model likely would improve working conditions for the AT, which can directly affect experiences of WLC. Several anecdotal reports have supported the move and have indicated improved quality of life due to normal working hours, flexibility with sport coverage, and increased feeling of value within the workplace.²⁹

Long work hours and limited time off can be exacerbated by staffing patterns within the collegiate setting; simply put, athletic training departments are not often meeting the guidelines determined by the NATA. To help administrators and head ATs address medical coverage needs and staffing concerns, the NATA has established guidelines regarding appropriate medical coverage for collegiate athletics.³⁰ The guidelines were established to help programs quantify the amount of medical coverage necessary and allow for each college or university to compute its needs based on a multitude of factors, thus personalizing the formula. Mazerolle et al²² found that many institutions do not meet these recommendations for various reasons, even though they can affect the AT's experiences of overload and WLC. Role overload, which occurs when the role requirements become overwhelming, especially as related to time and demands, was a major catalyst for WLC among our non-Division I ATs. Role overload is a form of role conflict, and WLC often has been described as a facet of role conflict.³¹ Athletic trainers in the collegiate setting experience role overload; Brumels and Beach¹³ reported that 38% experienced moderate to high levels of stress from role overload, a factor likely due to long work hours; a limited number of days off; and inadequate staffing patterns, which probably result in the long work hours and limited days off.

Whereas work overload is not a unique finding in our study, the nature of the overload is slightly distinctive from the Division I setting. Mazerolle et al²² reported that many Division I ATs are responsible for a minimum of 2 sports, often providing medical coverage to more than 50 athletes; however, our participants discussed providing “block” coverage, at times managing multiple teams and supplying medical care to a large number of athletes. Coupling limited staffing and athletic departments with a large number of teams, the AT working outside the Division I setting likely experiences WLC at times. Despite the recommendations of Laursen²⁹ about the benefits of transitioning away from sport assignments to a more patient-centered health care model, our observations suggested that without appropriate staffing, WLB may not be addressed. Appropriate staffing is a critical aspect of WLB, as it allows the AT to gain some degree of flexibility in a workplace environment that does not always afford it. Coworker support or teamwork has materialized as the means to promote flexible workplace practices in the collegiate setting.⁷

Flexible work practices involve affording an employee the freedom to establish a work schedule within certain boundaries as determined by the employer. These practices can benefit organizations and employees alike by promoting favorable job performance, reducing job-related stress,^32,33 and concurrently helping to attract and retain top talent.³⁴ The development of these practices reflects an employer's desire to help employees find WLB and include job sharing, flex time, compressed workweeks, and telecommuting.³⁵ These traditional flexible workplace practices are not compatible with the collegiate setting; however, it does appear that when ATs perceive that they have more control over their schedules or flexibility in work scheduling, they experience less WLC. This finding is consistent with the work of Pitney et al,⁶ who reported a similar observation in the secondary school setting. Flexibility is likely a product of collegial and supervisor support, which allows for occasional job sharing to facilitate WLB.

Our regression analysis revealed that years of experience was not a predictor of WFC for scale 1, but it was a predictor for scale 2. An explanation of the scale 1 data is that ATs with less experience may not have accumulated many family obligations pertaining to having a partner or spouse, with or without children, that conflict with their work lives. For the scale 2 data, perhaps unexpected facets of home life, as they relate to caring for parents, siblings, or grandparents, emerge as an AT accumulates more years of work experience.

Positive Factors Affecting WLB

Support networks are indispensable to sustaining WLB, especially for the AT. Researchers^7,22 have persistently identified the importance of having a support network as a means to balance and juggle all the roles assumed by the AT. Support networks should be diverse, composed of individuals who can help facilitate and manage tasks and duties within each role assumed. As our participants illustrated, support comes from colleagues and supervisors in the workplace, and family, friends, and spouses provide help outside the workplace. Whereas our findings are not unique, they yield support for workplace practices that involve a modified version of job sharing as described by the US Department of Labor,³⁶ including individuals sharing the responsibilities of 1 full-time position. As Winterstein et al proposed,³⁷ the underpinnings of job sharing are to allow individuals to distribute the duties associated with their roles within the collegiate setting so they have flexibility around work scheduling to meet domestic and personal obligations along with the demands of patient care. Job sharing can be implemented effectively only if and when supervisors support its application and coworkers are willing to use it appropriately.

Supervisors are often described as the gatekeepers of helping employees find WLB, as they need to support, endorse, and at times model these practices of work and life initiatives.¹⁵ Unlike many organizations, athletic training, particularly in the context of athletics, lacks formal workplace initiatives that endorse WLB. Rather, many informal practices, such as supervisor support, that help create a family-friendly atmosphere appear to exist. Goodman et al³⁸ identified the creation of a family-friendly and supportive workplace as a means to establish WLB within the collegiate setting and as an indirect retention initiative. Our work complements their findings by illuminating the need for a supervisor who advocates for his or her employees, recognizes the demands placed on them, and provides them with a degree of autonomy in the workplace. Our findings, coupled with those of Goodman et al,³⁸ indicated that a head AT who does not micromanage facilitates WLB; this management or leadership style blends synergy and laissez faire.

A supervisor's response to the demands placed on his or her employee can demonstrate sensitivity and understanding, and Hopkins³⁹ recommended this as helpful in reducing stress and conflict, which positively influences WLB and retention in the workplace. Social-identity theory, which is based on group relations and interactions, suggests that individuals perceive membership based on shared values and beliefs. As Hopkins³⁹ proposed, supervisors who demonstrate a mutual family-values system and value their employees beyond their work roles are likely to facilitate greater WLB. Our participants provided some support for this concept, indicating that given shared family values and obligations, their supervisors helped create WLB. This observation is not unique to the collegiate setting and also was reported by Mazerolle and Pitney⁴⁰ in the rehabilitation outreach setting.

Saying no and delegating tasks can be difficult yet critical when trying to find WLB. In the medical world, especially for physicians, requesting help in and out of the workplace is necessary because role conflict is inevitable without assistance.⁴¹ In our study, relying on and asking colleagues for assistance with practice, treatment, and game coverage was beneficial in juggling the demands of personal and home life. As mentioned, teamwork can provide a degree of flexibility in work and home scheduling. This ultimately may help to reduce the stress and conflict that can result from long work hours and demanding household and family responsibilities. Teamwork among a sports medicine staff has been found to transcend clinical setting.⁷ This notion was highlighted by Goodman et al,³⁸ and our observations showed that teamwork is critical for the collegiate AT to find a balanced lifestyle. We recognize that many of our observations are not exclusive to this study or occupational setting; however, support networks have often been contextualized as strongly benefitting the AT who is married or married with children.^7,12,15 Many of our unmarried participants discussed the advantages of having a friend or roommate to share in the household duties and responsibilities to reduce the burden of those monotonous, but basic, chores associated with life (eg, grocery shopping, cleaning). Regardless of the means, support networks are fundamental to WLB for every working employee but especially the AT who works long hours.

Making time for yourself has been recommended by researchers studying and advocating for work-life effectiveness.⁴² The idea of making “me” time may seem cliché, but the practice resonated with our participants and has been cited by those working in the secondary school setting⁴³ and collegiate setting²² as rudimentary in finding WLB. Maintaining a healthy balance between work and home life requires planning, time management, and a commitment to placing personal needs, at times, ahead of the job requirements of the AT. As described by Fereday and Oster,⁴⁴ creating and maintaining “protected time” away from the workplace is essential, necessary, and important for the individual working in health care. In unpublished research, we noted that this was particularly important, observing that ATs who felt rejuvenated due to the opportunity to get away were more committed to their organizations and the profession, a key to retaining an AT. Balancing professional and personal roles is a constant struggle for most working Americans, including those employed in health care,^2,3,22,41 and taking the time to care for oneself must become a priority, especially when the alternative could be a reduction in patient care due to conflict among work, family, life; burnout; and job dissatisfaction.^2,3 As Chittenden and Ritchie⁴¹ recommended, shifting the mindset to include both patient care and personal care is of utmost importance if we are to successfully manage professional duties and personal interests and obligations. Respectfully declining, saying no, scheduling personal time during each day, and shifting priorities or work duties are all means to help create this me time within the demanding confines of the collegiate athletic world.

Trisdale et al⁴⁵ reported that taking advantage of downtime, days off, and vacations helped male ATs find a balance, restore their WLB, and rejuvenate professionally. Ultimately, this provides personal time for ATs and allows them to handle responsibilities in their personal lives. Our participants also discussed the importance of protected time and me time, but a novel element was contract length for ATs outside Division I. Many ATs in the Division I setting have been employed on a 12-month contract that still requires structured work hours. With the new guidelines for summer practices and workouts, the time demands placed on ATs may affect the ability to use days off and vacation time. For our participants, the summer months were a time to plan vacations with friends and family, a means to decompress from the demands of the traditional sport seasons, and a time to reassume a more balanced lifestyle.

Limitations and Future Directions

Our participants came from a small random sample of 1250 ATs from the NATA membership directory. Our response rate was 25%, which was comparable with that of studies within the professional literature with similar online methods. A more robust sample might have provided stronger evidence about the WLB experiences of ATs outside Division I.

We followed the methods used by Pitney et al⁶ to examine WLC and WLB in this setting. However, we did not directly ask participants if the resources or practice setting in which they were employed specifically contributed to their experiences of WLC or fulfillment of WLB. The ATs who participated in phase II provided insight into the organizational factors that facilitate conflict, extending our understanding beyond the scores of the WFC scales. Researchers can continue to investigate whether a true difference exists among these levels within the collegiate practice setting and job responsibilities.

As mentioned, most researchers studying WLB in our profession have focused on the Division I clinical setting. Other clinical settings should continue to be examined to ascertain overall antecedents to WLB in our profession. In addition, evaluating organizational policies that may benefit the AT in achieving WLB is important in creating retention strategies for the profession as a whole.

Contract length emerged as a factor that helped this sample of ATs find WLB, as they could rejuvenate and refocus their energies during the summer months. Researchers need to pursue a longitudinal investigation to evaluate WFC experiences during various points of the contract for an AT because the levels of conflict may vary.

We did not examine the number of athletes in an AT's care or the number of teams with which he or she worked. These factors may be additional variables that affect whether one's work expectations influence WLB.

Finally, researchers need to investigate the effect of a shift toward a medical model for providing athletic training services. Quality patient care is the primary focus for the AT, and long working hours and stressful jobs can affect one's performance. Currently, few empirical data exist regarding the quality of patient care as influenced by experiences of WLC and the occupational setting.

CONCLUSIONS

Our study continues to show that organizational factors influence WLC and WLB for the AT. The level of WLB for these non-Division I ATs is comparable with that experienced by ATs in the Division I setting. Overload continues to be a prevalent factor in negatively influencing WLB, and supervisor and peer support, personal networks, and time away from the role continue to be factors that positively influence WLB. As are physicians and nurses, ATs are required to work long hours due to the demands of patient care and the importance of “face time” in completing many of the responsibilities associated with their roles. To mitigate conflicts and maintain a semblance of WLB, ATs are encouraged to support one another in the workplace, especially when providing flexibility in work scheduling. Supervisors should support and encourage the concept of job sharing, whereby colleagues help one another when feasible to provide opportunities to attend personal and family obligations and outings. To that end, the addition of qualified athletic training personnel should be considered by supervisors as an important step to enable such strategies and reduce the overload on existing staff.