Athletic Training and Sports Health Care

Systematic Review Supplemental Data

Characteristics of Burnout Among Collegiate and Secondary School Athletic Trainers: A Systematic Review

Sarah J. Cayton, DAT, LAT, ATC; Tamara C. Valovich McLeod, PhD, ATC, FNATA

Abstract

Purpose:

To provide an overview of the literature examining burnout among athletic trainers currently or previously employed in collegiate or secondary school settings.

Methods:

Characteristics, risk factors, predictors, and coping strategies related to burnout among athletic trainers were identified. Studies published between 1986 and 2017 that investigated the burnout phenomenon among collegiate and secondary school athletic trainers in relation to work–family conflict, personality, gender, role complexities, and management and/or preventative strategies were selected. Nineteen studies were identified and categorized into three specific aims (ie, characteristics, risk factors, and coping strategies of burnout).

Results:

Burnout was positively correlated with role strain, stress, neuroticism, and work–family conflict, although some inconsistency existed between demographics and study design. No significant sex differences were found despite varying years of experience, education, job responsibilities, and family status.

Conclusions:

Strategies to promote work–life balance and reduce stress are available; however, longitudinal studies are necessary for the athletic training profession.

[Athletic Training & Sports Heath Care. 201X;XX(X):XX–XX.]

Abstract

Purpose:

To provide an overview of the literature examining burnout among athletic trainers currently or previously employed in collegiate or secondary school settings.

Methods:

Characteristics, risk factors, predictors, and coping strategies related to burnout among athletic trainers were identified. Studies published between 1986 and 2017 that investigated the burnout phenomenon among collegiate and secondary school athletic trainers in relation to work–family conflict, personality, gender, role complexities, and management and/or preventative strategies were selected. Nineteen studies were identified and categorized into three specific aims (ie, characteristics, risk factors, and coping strategies of burnout).

Results:

Burnout was positively correlated with role strain, stress, neuroticism, and work–family conflict, although some inconsistency existed between demographics and study design. No significant sex differences were found despite varying years of experience, education, job responsibilities, and family status.

Conclusions:

Strategies to promote work–life balance and reduce stress are available; however, longitudinal studies are necessary for the athletic training profession.

[Athletic Training & Sports Heath Care. 201X;XX(X):XX–XX.]

Athletic trainers are health care professionals employed in secondary school, university, industrial, and clinical settings who serve under stressful conditions (ie, long work hours and work overload) that are often emotionally draining and require a great deal of interpersonal contact with patients, coaches, and administrators.1–8 A demanding work environment is often associated with high emotional involvement and stress, responsibility, and unrealistic expectations in regard to time and availability. Low pay coupled with little time off, inadequate staffing, and long work hours have led to burnout and attrition.1,2,5,8–11

Burnout has been consistently defined as a phenomenon characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment manifesting itself through many physiological, behavioral, and/or psychological symptoms, such as difficulty sleeping, poor appetite, headache, depression, and attrition.10–14 Burnout among athletic trainers has been widely investigated and associated with many factors, such as perceived stress, perceived wellness, personal and environmental characteristics, employment setting, job satisfaction, professional role complexity, personality traits, social interactions, and work load.2,4,5,9–12,14–22 However, participants within each study had varying backgrounds (eg, collegiate program directors in athletic training programs, secondary school athletic trainers, collegiate athletic trainers with singular or multiple roles, and athletic trainers with or without families).

Current and previous research has measured burnout in athletic training via various valid and reliable survey instruments to identify relationships between burnout, demographics, and numerous personal and environmental characteristics, including (but not limited to) the Maslach Burnout Inventory, Copenhagen Burnout Inventory, Occupational Engagement Scale, and the Athletic Training Burnout Inventory.2,10–17 In addition to identifying facets of burnout within varying athletic trainer employment settings, it is also crucial to highlight coping skills and strategies that have been found to achieve work–life balance, which may improve job satisfaction, perception of working conditions, and job retention in various clinical settings.23 Currently, the information available is focused around athletic trainers employed in traditional athletic training settings (ie, secondary school and universities) who have experienced work–family conflict. Athletic trainers who prioritized personal time gained interpersonal support from athletic directors, administrators, coaches, and athletic training colleagues to implement work schedule flexibility. Adding athletic training staff, integrating family into the workplace, and social support from family and friends have been shown to be effective in decreasing work–family conflict.8,22–24 Family integration was found to be successful when supported by administration and coaches in secondary schools that allowed athletic trainers to bring their children to practice or games and/or eat dinner with their family prior to games that frequently extended into the late evening.8,24 In contrast, athletic trainers employed in a clinical rehabilitation setting found work–life balance in a stable, predetermined work schedule with a workload of approximately 45 hours per week that allowed for personal and family obligations.24

Therefore, the purpose of this systematic review was to provide a thorough review of the literature and disseminate the complexity of burnout among collegiate and secondary school athletic trainers organized into the themes of characteristics, risk factors, and coping strategies. We systematically evaluated and synthesized the literature regarding characteristics and reported levels, risk factors, and predictors of burnout among college and secondary school athletic trainers. We also examined the use of coping strategies for managing and preventing burnout among collegiate and secondary school athletic trainers.

Literature Review

This systematic review was conducted by adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.25 Based on these guidelines, the criteria for study inclusion, data collection, and extraction were employed.

Search Strategy

A formal search of the literature was performed in December 2017 using the search terms “burnout and secondary school athletic trainers and burnout” and “collegiate athletic trainers,” yielding results from PubMed, CINAHL Plus, SPORTDiscus, and Cochrane Library databases (Table A, available in the online version of this article).

Search Terms, Databases, and Counts

Table A:

Search Terms, Databases, and Counts

Study Selection and Data Extraction

A compilation of search results was performed and organized by database. Duplicates were identified and removed from the initial studies. Abstract and title reviews were performed. Exclusion criteria were studies with a lack of relevance to the clinical question or specific aim and studies with a population of graduate assistant athletic trainers. Studies were also excluded if they published the abstract only, were outside of the publication date range, or did not provide a measure of burnout.

Full-text reviews were performed on the remaining studies, excluding those failing to meet inclusion criteria. A hand search was completed via examining reference lists of the journal articles to account for studies not captured in the formal database search, with title/abstract and full-text reviews performed to determine inclusion. Abstract/title reviews and full-text reviews were performed by two authors (SJC, TCVM), yielding 19 studies chosen for inclusion of this systematic review (Figure 1).

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.

The data extracted from each study included demographic information of the population sample, study design, type of outcome instrument(s), results, and study implications (Tables BC, available in the online version of the article).

Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers

Table B:

Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers

Coping Strategies for Managing and Preventing Burnout among Collegiate and Secondary School Athletic Trainers

Table C:

Coping Strategies for Managing and Preventing Burnout among Collegiate and Secondary School Athletic Trainers

Search Results

The database search yielded 45 studies published between 1986 and 2017. After duplicates were removed, 22 studies were thoroughly evaluated and 19 studies were included in this review. Significant findings from these studies are presented in Tables BC.

Findings

Risk Factors and Predictors of Burnout

Risk factors, predictors, and reported levels of burnout have been investigated among secondary school and collegiate athletic trainers via various instruments to understand the manifestation of the burnout phenomenon (Table B).2–5,7,9,19,26–28

Role Strain . One commonly reported characteristic related to burnout among collegiate athletic trainers is role strain.3,26,29 Dorrel et al.26 studied role strain, including role overload, role ambiguity, and role conflict (ie, role complexities) in athletic trainers working in a collegiate setting. In the current study, the Role Strain Scale was administered to collegiate athletic trainers with dual role appointments (eg, clinical preceptor and teaching) and found that approximately half of the participants experienced moderate to high levels of role strain, with role overload contributing the highest, followed by hours worked per week (> 50 hours/week, 53%), number of credits taught (> 3 hours/semester, 35%), and number of students supervising as a clinical preceptor (≥ 5 students/semester). Similarly, athletic trainers in National Collegiate Athletic Association (NCAA) Division II universities who worked more than 10 hours per day agreed that the workload was overly demanding.3

Role complexities not only contribute to role strain, but are also predictive of burnout. The combination of role ambiguity, role conflict, number of hours worked, and locus of control was predictive of overall burnout in a sample of 332 NCAA Division I and secondary school athletic trainers, with role conflict contributing the most.3 However, burnout frequency and intensity was predicted by the combination of role ambiguity, role conflict, number of hours worked, number of athletes, and external locus of control, with role conflict contributing the most.29 Role conflict was the best predictor of emotional exhaustion and depersonalization, whereas role ambiguity best predicted personal accomplishment on all subscales on the Maslach Burnout Inventory.29

Although role complexities have been identified as strong predictors of facets of burnout, one sample of athletic trainers was overall less affected compared to similar health care professionals in other studies.5 Clinicians, faculty, and joint appointees all reported overall minimal role complexity. Role incongruity negatively predicted job satisfaction in the study population, whereas role ambiguity and role incongruity combined predicted intent to leave the current job. Role overload and role incompetence influenced intent to leave the profession in the study population. Role incongruity predicted job satisfaction, intent to leave the current job, and intent to leave the profession for clinicians, whereas role conflict predicted intent to leave the profession for joint appointees.5 However, role complexities were not analyzed against specific burnout scales in this study, resulting in the possibility that type of role complexity could be related to some degree of burnout that creates feelings of intent to leave a current job or the profession, despite the lack of significance in job satisfaction and type of role.5 Role complexities are defined in Figure 2.

Definitions of role complexities.

Figure 2.

Definitions of role complexities.

Stress . Stress created from various facets of work has been associated with characteristics of burnout. Role complexities among collegiate athletic trainers produced moderate to high stress levels, whereas hardiness, a personality trait, significantly predicted perceived stress in athletic trainers employed in NCAA Division I-A universities.5,16,26 Stress level and pressure by a coach to medically clear an athlete was predictive of each burnout subscale.11 Stress has also been shown to be moderately associated with the depersonalization and emotional exhaustion subscales on the Maslach Burnout Inventory, in addition to somatic health complaints among athletic trainers in various other settings (r = 0.33).16,17 Conversely, higher scores on the personal accomplishment subscale were associated with lower perceived stress. Overall, burnout scores were associated with higher levels of perceived stress.2

Occupational Engagement . Contrary to aspects of stress experienced by athletic trainers, Giacobbi17 affirmed that “occupational engagement is a positive antipode of burnout” (p. 371). Vigor, absorption, and dedication are constructs of occupational engagement, whereas emotional exhaustion, depersonalization, and decreased personal accomplishment characterize burnout, the inverse of occupational engagement.17 Vigor, characterized by energy and passion for work, was more represented in men than women and athletic trainers employed in collegiate settings. Women and collegiate athletic trainers scored higher on emotional exhaustion and depersonalization, respectively.17 Collegiate female athletic trainers also reported moderate to high levels of burnout on each subscale of the Copenhagen Burnout Inventory.12 Regardless of women and collegiate athletic trainers experiencing increased symptoms of burnout, personal accomplishment was associated with all three subscales on the Occupational Engagement Scale (ie, vigor, dedication, and absorption), indicating that athletic trainers on average exhibit higher levels of engagement within the profession.17

Personality Traits . Although not strong predictors of burnout, personality types (ie, neuroticism, agreeableness, and extraversion) slightly influenced the development of burnout among a sample of athletic trainers who had been certified 5 ± 3 years.10 Neuroticism was found to be positively correlated with burnout, whereas extraversion and agreeableness were negatively correlated, indicating athletic trainers possessing these personality traits may be less susceptible to burnout. Eason et al.9 found a moderate positive relationship between agreeableness and overall job satisfaction, similar to a finding by Barrett et al.10 which reported that neuroticism and overall job satisfaction had a moderate negative relationship. In the current study, agreeableness was the strongest predictor of job satisfaction.9 Although these studies report negative and positive relationships between various personality types and aspects of burnout, the samples were not studied longitudinally and may only be applicable to the point in time in which the data were collected.9,10

The number of hours worked in a season in combination with years of experience and income were greater predictors of burnout than personality traits alone. Similar to other studies, a combination of factors, in which hours worked is a constant, leads to either role strain or burnout.10,17,26,29

Work–Family Conflict . Work–family conflict often overlaps with characteristics of burnout (eg, hours worked, lack of flexibility in work schedules, and risk factors for burnout).8,12,19,24,27 Inflexible work schedules due to last-minute change of practice time, lack of staffing/resources, or never having schedule flexibility affect work–life conflict.8,24 Male and female athletic trainers have discussed similar reasons why they chose to leave the NCAA Division I collegiate setting.27,28 Goodman et al.28 interviewed 23 female athletic trainers who reported life balance issues, organizational conflicts with coaches or supervisors, role overloads, role conflicts, and kinship responsibilities. Mazerolle et al.27 found similar findings among male athletic trainers who chose to leave after 15 ± 11 years of experience in NCAA Division I institutions due to role strain (ie, “being worn out”), work–family conflict (“only seeing his daughter when she was sleeping”), role transition (“retire and change the pace of life”), and lack of career advancement (“my head athletic trainer said until I leave, there is really no move for you”).

Male and female athletic trainers also reported their current employment settings were not supportive of parental responsibilities, yet stated that having children did not affect their work.6,19 Women had the propensity to feel guilty when having to leave work for family or choosing work over family, found it stressful to manage work and family (causing burnout), and were less likely to use work-leave benefits.6,19 Similar to the study by Mazerolle et al.,27 collegiate athletic trainers also expressed strongly that their families were neglected due to work, that the demands of the profession (ie, hours worked and travel) contributed to difficulty managing time and making new connections outside of the work environment, and they were fatigued.6,24 Higher work–family conflict scores were reported in collegiate and secondary school athletic trainers, with men experiencing slightly higher work–family conflict than women. However, in the current study, women scored higher on willingness to leave the profession, although no significant sex differences were found.19

Coping Strategies

Organizational Support . Factors contributing to work–family conflict have led to the development of strategies to improve work–life balance and were discussed in three studies (Table B). Athletic trainers should consider proposing and implementing organizational policies to promote work–life balance, such as receiving help from coworkers and establishing guidelines for the athletic training facility.22,24,30 The following statements substantiate these findings: “My coworkers are willing to help me out. This is why our system and staff here works” and “Establishing rules and daily rehabilitation/treatment times for athletes and coaches to follow has been an effective way for me to have a schedule [so] I know when I can expect down time.”24

Personal Factors . Family support and work–life separation were also shared as effective strategies to improve work–life balance.24 Athletic trainers provided the following statements to help gain understanding of how life balance has been achieved: “. . .my family has learned to schedule around the football season, since I don't get a day off from August to December,” “my family never makes me feel guilty about my life balance or lack of balance,” and “leave all of the issues and problems from work at work.”24 Family integration and setting professional boundaries into the work environment have helped athletic trainers with varying family situations, roles, and ages employed in various settings find work–life balance. Prioritizing family dinners at or away from work, establishing personal time, and learning to say “no,” thereby gaining control of work scheduling, have also been effective.23,30 Finally, several athletic trainers made suggestions of ways to the combat the lack of resources, such as hiring per diem athletic trainers to ensure adequate medical coverage or reducing workload and time spent at work by establishing clear guidelines for staffing patterns and sport coverage.30

Physical Activity . In addition to implementing organizational policies and setting professional boundaries, receiving support from family, work–life separation, and integrating family into the workplace, athletic trainers should consider using exercise as a strategy to combat stress. Exercise behavior has been positively associated with vigor (r = 0.15), a subscale of the Occupational Engagement Scale, and personal accomplishment (r = 0.18). In fact, athletic trainers in this study averaged 2.5 sessions of strenuous exercise per week, which was measured by the Leisure-Time Exercise Questionaire.17 Similarly, Naugle et al.12 reported women were found to achieve more physical activity on each subscale of the Baecke Physical Activity Questionare. Overall, an increase in physical activity was correlated with higher levels of perceived wellness; however, levels of physical activity declined with years of experience in the study sample.12

Although only two studies were reviewed regarding physical activity as a strategy to improve occupational engagement and minimize stress, the findings of these studies advocate regular exercise to cope with work-related stress.12,17

Discussion

The primary findings of this systematic review were that athletic trainers who experienced role strain and work-related stress and displayed a neurotic personality reported some degree of burnout, yet several athletic trainers found useful strategies to reduce risk factors and negative effects of burnout.2,3,10–12,16,17,23,24,26,29,30 Variables associated with burnout (eg, demanding work schedules, perceived stress, and role complexities) have also contributed to work–family conflict, making it difficult for male and female athletic trainers to remain in the athletic training profession.6,8,12,19,24,27,28 Role conflict and role ambiguity can predict each dimension of burnout.3,5,29 However, other role complexities were found to predict job dissatisfaction, intent to leave a job, and/or intent to leave the athletic training profession among athletic trainers' employed in a collegiate setting with various roles or appointments.5 Stress was also predictive of each dimension of burnout among collegiate athletic trainers.11 Similar to the association of neuroticism and burnout, perceived stress was also predicted by Division I-A athletic trainers who possessed hardiness, which leads to the assumption that personality type may influence the risk for an athletic trainer employed in a collegiate setting to experience high levels of stress and, consequently, burnout.16

Despite athletic trainers' susceptibility to burnout through numerous risk factors and work attributes related to the athletic training profession, many strategies for creating work–life balance have been described in the literature. Integrating family into the work environment, obtaining support from colleagues and supervisors, displaying an agreeable personality, adequate staffing, encouraging personal time, and prioritizing time well while at work and home have been consistently reported.9,23,24,30 As employment evolves within the athletic training profession, it will be helpful to revisit these strategies and their usefulness in combating stress and burnout among athletic trainers in non-traditional settings.

Although empathy has been found to reduce burnout in other health care professionals, it may also contribute to the burnout phenomenon by means of demonstrating continual compassion and physical and/or emotional fatigue while delivering patient care.31,32 Various types of empathy exist with clinical empathy, characterized by understanding the inner experiences and perspectives of the patient as a separate individual combined with the capability to communicate this understanding to the patient.32 For example, primary care providers who displayed empathy were found to experience a greater sense of self-accomplishment and satisfaction with his or her delivery of patient care through reflection of practice, awareness of emotions, and learning to accept constructive criticism.32 The self-accomplishment experienced by primary care providers seems comparable to the personal accomplishment experienced by collegiate athletic trainers who exhibited higher levels of occupational engagement and could become an effective strategy for reducing burnout.17 Clinical empathy has been suggested to be the most appropriate for physicians; however, it is unknown which type, if any, would be effective in reducing burnout in athletic trainers.32

Currently, the literature substantiates strategies to reduce risk of burnout, work–family conflict, and perceived stress in athletic trainers, including understanding the potential influence of personality type in the development of burnout, initiating/maintaining communication with supervisors and colleagues about creating flexibility in schedules, clearly defining job responsibilities, using per diem athletic trainers, hiring additional athletic trainers, and promoting overall teamwork to reduce the workload and beginning or maintaining an active lifestyle.9,12,17,23,24,30

This review was conducted by establishing clear inclusion/exclusion criteria, a comprehensive search strategy, and full-text reviews by both authors to provide a thorough synthesis of the available literature on characteristics of burnout among collegiate and secondary school athletic trainers. However, limitations do exist. The population included was limited to athletic trainers employed in collegiate or secondary schools and excluded graduate assistants, although some studies did include athletic trainers in other settings within their sample. The year of publication was also limited to 1986 to 2017, which may have excluded literature recently published that could aid in the understanding of burnout within this athletic trainer cohort. Therefore, expanding the inclusion criteria to capture burnout characteristics among other athletic trainers in non-traditional settings such as industrial settings, clinic/outreach positions, or athletic trainers employed in a physician's practice should be considered. Following the composition of this review, Mazerolle et al.22 published a position statement on facilitating work–life balance in athletic training practice settings that highlighted similar coping strategies for achieving work–life balance, antecedents for work–life conflict, and consequences of work–life conflict such as attrition, job dissatisfaction, and burnout in athletic training.

Although this review gives valuable insight to the phenomenon of burnout among athletic trainers, gaps in the literature remain. To our knowledge, there is limited information regarding the association of personality traits of athletic trainers with burnout, which does not include which employment setting is better suited for athletic trainers displaying specific personality traits in an effort to reduce burnout and stress.10 The influence of personality traits throughout an athletic trainer's career should be studied longitudinally to capture differences in personality, burnout frequency and intensity, job satisfaction, ability to balance work and life, and attrition rates.9,23

Compared to other health care professions, athletic trainers are underrepresented in the burnout literature; therefore, longitudinal studies should also examine additional symptomology to determine stages of burnout and fluctuations in burnout symptoms over academic years and sport seasons in addition to analyzing potential differences between male and female athletic trainers and athletic trainers in various levels of collegiate institutions.11,16

In an effort to guide work–life balance, research is needed to understand which employment settings are most suitable for desired family goals, career path, and the effectiveness of implementing family integration in current employment settings.6,24 Work–life balance strategies in other levels of collegiate institutions, among male and female athletic trainers with children, single, or married without children, should be explored.23

Finally, role complexities should be investigated in other employment settings (ie, secondary schools, clinics, and physician offices). Studies should follow athletic trainers in these settings to determine whether establishing clear expectations and job responsibilities through effective communication reduces role strain and burnout.5,29

Conclusions

This is the first systematic review of characteristics, risk factors, and reported levels of burnout and coping strategies for managing and preventing burnout among collegiate and secondary school athletic trainers. In the past decade, there has been an increase in the investigation of burnout (specifically work–life balance and work–family conflict) among athletic trainers, which brings awareness to currently practicing and future athletic trainers. The current knowledge and understanding of burnout should encourage researchers to examine the persistence of burnout among athletic trainers. Coping and preventative strategies have not been widely investigated in athletic training, which may affect the stagnancy of this phenomenon.

To promote better work–life balance, athletic trainers should consider setting professional boundaries through effective communication with employers, coaches, and supervisors in an effort to reduce workload and gain rapport, prioritize personal and family time, and openly discuss clear job responsibilities/roles prior to start or transition to a new position with an employer and/or direct supervisor, and understand his or her own abilities and/or limitations in a work environment.5,8,23,24,29,30 Athletic trainers may also need to discern which employment settings will be and remain supportive of family responsibilities prior to accepting a position.6,19 Work–life balance could also be encouraged by administrators who are open to creating an organizational policy with staff athletic trainers that supports family integration into the work environment and minimizes hours worked by setting guidelines for sport coverage and evaluation/rehabilitation visits.8,23,30 Administrators should take an interest in the quality of life of athletic trainers at their institutions, and encourage time away from work in an effort to minimize role strain and reduce attrition.6,19,28

References

  1. Balogun JA, Titiloye V, Balogun A, Oyeyemi A, Katz J. Prevalence and determinants of burnout among physical and occupational therapists. J Allied Health. 2002;31:131–139.
  2. DeFreese JD, Mihalik JP. Work-based social interactions, perceived stress, and workload incongruence as antecedents of athletic trainer burnout. J Athl Train. 2016;51:28–34. doi:10.4085/1062-6050-51.2.05 [CrossRef]
  3. Belle SE. Perceived Workloads of National Collegiate Athletics Association Division II Certified Athletic Trainers [master's thesis]. Chapel Hill: University of North Carolina; 2001.
  4. Mazerolle SM, Pitney WA, Eason CM. Experiences of work-life conflict for the athletic trainer employed outside the National Collegiate Athletic Association Division I clinical setting. J Athl Train. 2015;50:748–759. doi:10.4085/1062-6050-50.4.02 [CrossRef]
  5. Brumels K, Beach A. Professional role complexity and job satisfaction of collegiate certified athletic trainers. J Athl Train. 2008;43:373–378. doi:10.4085/1062-6050-43.4.373 [CrossRef]
  6. Eberman LE, Kahanov L. Athletic trainer perceptions of life-work balance and parenting concerns. J Athl Train. 2013;48:416–423. doi:10.4085/1062-6050-48.2.01 [CrossRef]
  7. Mazerolle SM, Bruening JE, Casa DJ, Burton LJ. Work-family conflict, part II: job and life satisfaction in National Collegiate Athletic Association Division I-A certified athletic trainers. J Athl Train. 2008;43:513–522. doi:10.4085/1062-6050-43.5.513 [CrossRef]
  8. Pitney WA, Mazerolle SM, Pagnotta KD. Work-family conflict among athletic trainers in the secondary school setting. J Athl Train. 2011;46:185–193. doi:10.4085/1062-6050-46.2.185 [CrossRef]
  9. Eason CM, Mazerolle SM, Monsma EV, Mensch JM. The role of personality in job satisfaction among collegiate athletic trainers. J Athl Train. 2015;50:1247–1255. doi:10.4085/1062-6050-50.11.08 [CrossRef]
  10. Barrett J, Eason CM, Lazar R, Mazerolle SM. Personality traits and burnout among athletic trainers employed in the collegiate setting. J Athl Train. 2016;51:454–459. doi:10.4085/1062-6050-51.7.08 [CrossRef]
  11. Kania ML, Meyer BB, Ebersole KT. Personal and environmental characteristics predicting burnout among certified athletic trainers at National Collegiate Athletic Association institutions. J Athl Train. 2009;44:58–66. doi:10.4085/1062-6050-44.1.58 [CrossRef]
  12. Naugle KE, Behar-Horenstein LS, Dodd VJ, Tillman MD, Borsa PA. Perceptions of wellness and burnout among certified athletic trainers: sex differences. J Athl Train. 2013;48:424–430. doi:10.4085/1062-6050-48.2.07 [CrossRef]
  13. Clapper DC, Harris LL. Reliability and validity of an instrument to describe burnout among collegiate athletic trainers. J Athl Train. 2008;43:62–69. doi:10.4085/1062-6050-43.1.62 [CrossRef]
  14. Walter JM, Van Lunen BL, Walker SE, Ismaeli ZC, Onate JA. As assessment of burnout in undergraduate athletic training education program directors. J Athl Train. 2009;44:190–196. doi:10.4085/1062-6050-44.2.190 [CrossRef]
  15. Gibson AM, Cohen GW, Boyce KK, Houston MN, Welch Bacon CE. Personal and environmental characteristics associated with burnout in athletic trainers: a critically appraised topic. Int J Athl Ther Train. 2016;21:5–13. doi:10.1123/ijatt.2015-0017 [CrossRef]
  16. Hendrix AE, Acevedo EO, Hebert E. An examination of stress and burnout in certified athletic trainers at division I-A universities. J Athl Train. 2000;35:139–144.
  17. Giacobbi PR Jr, . Low burnout and high engagement levels in athletic trainers: results of a nationwide random sample. J Athl Train. 2009;44:370–377. doi:10.4085/1062-6050-44.4.370 [CrossRef]
  18. Keeley K, Walker SE, Hankemeier DA, Martin M, Cappaert TA. Athletic trainers' beliefs about and implementation of evidence-based practice. J Athl Train. 2016;51:35–46. doi:10.4085/1062-6050-51.2.11 [CrossRef]
  19. Mazerolle SM, Eason CM, Pitney WA, Mueller MN. Sex and employment-setting differences in work-family conflict in athletic training. J Athl Train. 2015;50:958–963. doi:10.4085/1052-6050-50.2.14 [CrossRef]
  20. Reed S, Giacobbi PR Jr, . The stress and coping responses of certified graduate athletic training students. J Athl Train. 2004;39:193–200.
  21. Mazerolle SM, Eason CM. Perceptions of National Collegiate Athletic Association Division I female athletic trainers on motherhood and work-life balance: individual- and sociocultural-level factors. J Athl Train. 2015;50:854–861. doi:10.4085/1062-6050-50.5.02 [CrossRef]
  22. Mazerolle SM, Pitney WA, Goodman A, et al. National Athletic Trainers' Association Position Statement: facilitating work-life balance in athletic training practice settings. J Athl Train. 2018;53:796–811. doi:10.4085/1062-6050-51.11.02 [CrossRef]
  23. Mazerolle SM, Pitney W, Goodman A. Strategies for athletic trainers to find a balanced lifestyle across clinical settings. Int J Athl Ther Train. 2012;17:7–14. doi:10.1123/ijatt.17.3.7 [CrossRef]
  24. Mazerolle SM, Pitney W, Casa DJ, Pagnotta KD. Assessing strategies to manage work andl life balance of athletic trainers working in the National Collegiate Athletic Association Division I setting. J Athl Train. 2011;46:194–205. doi:10.4085/1062-6050-46.2.194 [CrossRef]
  25. Moher D, Liberati A, Tetzlaff J, Altman DGPRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi:10.1136/bmj.b2535 [CrossRef]
  26. Dorrel B, Symonds ML, Lammert J. Role strain in dual role collegiate athletic trainers. MO J Health, Physical Education, Recreation, and Dance. 2014;24:40–54.
  27. Mazerolle SM, Pitney WA, Goodman A. Factors influencing the decisions of male athletic trainers to leave the NCAA Divison-I practice setting. Int J Athl Ther Train. 2013;18:7–12. doi:10.1123/ijatt.18.6.7 [CrossRef]
  28. Goodman A, Mensch JM, Jay M, French KE, Mitchell MF, Fritz SL. Retention and attrition factors for female certified athletic trainers in the National Collegiate Athletic Association Division I football bowl subdivision setting. J Athl Train. 2010;45:287–298. doi:10.4085/1062-6050-45.3.287 [CrossRef]
  29. Capel SA. Psychological and organizational factors related to burn-out in athletic trainers. Resarch Quarterly for Exercise and Sport. 1986;57:321–328. doi:10.1080/02701367.1986.10608093 [CrossRef]
  30. Mazerolle SM, Bruening JE. Work-family conflict, part 2: how athletic trainers can ease it. Athl Ther Today. 2006;11:47–49. doi:10.1123/att.11.6.47 [CrossRef]
  31. Wilkinson H, Whittington R, Perry L, Eames C. Examining the relationship between burnout and empathy in healthcare professionals: a systematic review. Burn Res. 2017;6:18–29. doi:10.1016/j.burn.2017.06.003 [CrossRef]
  32. Zenasni F, Boujut E, Woerner A, Sultan S. Burnout and empathy in primary care: three hypotheses. Br J Gen Pract. 2012;62:346–347. doi:10.3399/bjgp12X652193 [CrossRef]

Search Terms, Databases, and Counts

Search terms Cochrane Library CINAHL SportDiscus PubMed Grand Total
Secondary school athletic trainer AND burnout 0 1 3 13 17
Collegiate athletic trainers AND burnout 0 7 8 13 28
Grand Total 0 8 11 26 45

Risk Factors and Predictors of Burnout Among Collegiate and Secondary School Athletic Trainers

Author(s) Study Design Participant Demographics Outcome Instrument Results Study Implications
Barrett J, et al.10 Cross-sectional NATA members (65 men, 124 women) **Years certified = 5±3 years Self-report burnout scale Big Five Inventory (BFI) * Moderate burnout=17.2±5.76**Extraversion and burnout= −0.229**Agreeableness and burnout= −0.245**Neuroticism and burnout=0.385 Utilize other instruments in conjunction with the BFI to assess personality in AT's.
Belle SE3 Survey 91 NCAA Division II athletic trainers 5-point Likert scale on perceptions of workload NCAA athletic program and athletic training staff demographic survey ** Overly demanding workloads = 3.79**Work >10 hours/day = 4.05**Hours worked per week: 41.3**Work 2 weeks straight = 3.5385**Lack of resources/staff = 2.36**Frustration due to lack of resources = 3.6556 Future research should be centered around evaluating the amount of time required to perform other duties not directly related to athletic training or care of the athlete. Need to establish realistic baselines for salary, resources, and staffing.
Brumels K and Beach A5 Survey 348 NATA members (130 clinicians, 62 faculty, 146 joint appointment, 10 other role) Modified Role Strain Scale ** Job satisfaction: clinician=4.43 ±1.32, faculty= 4.82 ± 1.25, joint appointees=4.49 ± 1.30**Intent to leave job: clinician= 2.58 ± 1.01, faculty= 2.16 ± 0.93, joint appointees= 2.61 ± 1.03**Intent to leave profession: clinician=2.08 ± 1.04, faculty=1.69 ± 0.82, joint appointees= 2.00 ±0.97 Future research should focus on investigating role complexity as years of experience increase. Investigate factors contributing to role incongruity in clinical AT's in higher education. Role complexities should be investigated in other athletic training settings (i.e. secondary schools, clinics, physician offices). Perform longitudinal studies in AT's employed in employment settings in which clear expectations and job responsibilities were or were not communicated.
Capel SA29 Cross-sectional 332 certified athletic trainers(23% high school athletic trainers, 21% division I university athletic trainers) **Age = 31.3 years Maslach Burnout Inventory Role Questionnaire, Rotter Internal-External Locus of Control Scale Demographic and Organizational Data Questionnaire ** Role conflict = 3.0**Role ambiguity = 5.2**Locus of control = 9.5**Personal accomplishment = 5.20**Emotional exhaustion = 2.84**Depersonalization = 1.95 Reduce role conflict and role ambiguity through establishing clear roles, developing skills for conflict resolution, and improving communication between staff within the athletic program/department may lead to decreased incidence of burnout. Reduce number of athletes under the AT's care and number of hours worked per week to lower burnout rates.
DeFreese JD and Mihalik JP2 Cross-sectional 150 NATA members (78 men, 76 women) **Age= 36.8 ± 9.5 years Demographics Workload Incongruence Measure Perceived Stress Scale (PSS) Social Support Questionnaire (SSQ) Positive and Negative Social Exchanges Maslach Burnout Inventory-Human Services Survey(MBI-HS) Higher emotional exhaustion was associated with higher perceived stress and workload incongruence, and lower social support scores. Higher depersonalization was associated with higher perceived stress and negative social interactions, but lower social support scores. High personal accomplishment was associated with lower perceived stress. Higher overall burnout scores were associated with higher levels of perceived stress and workload incongruence, and lower level of social support. Future research should explore how coping resources and optimism correlated with AT stress, workload, and burnout. Larger study samples, stratified by practice setting are also needed in order to explain the development of burnout in AT's. The addition of the Task Load Index is recommended to examine the workload antecedent of AT burnout.
Dorrel B, et al.26 Non-experimental survey 190 collegiate athletic trainers with dual role positions Role strain scale 53% of participants worked >50 hours/week 35% of participants taught >3 credit hours/semester 19% of participants working at institutions with athletic training program served as a clinical preceptor for ≥5 students/semester AT's at institutions with small staff sizes and large numbers of student-athletes should be investigated to determine role strain, burnout, job dissatisfaction, and intention to leave their setting or AT profession. Examine strategies of how dual role ATs manage duties and minimize role strain.
Eason CM, et al.9 Cross-sectional 202 collegiate AT's (68 men, 134 women). **Years certified= 4.99±2.67**Years at current institution= 2.91±2.25**Number of athletes= 119.31±104.84**Number of staff AT's=4.16±3.25**Travel days/month in season=6.89±5.98**Travel days/month out of season=1.18±2.59 Demographic survey Job Satisfaction Survey (JSS) Big Five Personality Inventory (BFI) Neuroticism higher in women. Weak negative relationship between extroversion, years certified, and years at current institution. Weak negative relationship between agreeableness and years certified. Weak positive relationships between extroversion and conscientiousness and overall job satisfaction. Moderate positive relationship between agreeableness and overall job satisfaction. Moderate negative relationship between neuroticism and overall job satisfaction. Agreeableness was the strongest predictor of job satisfaction. Less job satisfaction occurs as years certified and years at current institution increase. Measure influence of personality longitudinally. Need to explore other facets of personality such hardiness, resiliency, and the association with job satisfaction. Explore the relationship of how personality and job satisfaction affect the athletic training working environment.
Eberman LE and Kahanov L6 Survey 1962 NATA members employed full-time (males=954, females=816) 28-item questionnaire relating to demographics, life-work balance, family obligations, parenting, and non-parenting. 26.5% of participants desire to have children Females display increased guilt with work-family conflict. Male and females reported their current employment setting were not supportive of parental responsibilities but disagreed that having children affect their work. Men expressed difficulty creating balance as a working parent while women expressed managing work and family was stressful and caused burnout. Collegiate AT's expressed strongly that their families were neglected due to work. Research needed to understand which employment settings are best suitable for desired family goals and career path. Examining the values of AT's over a life span may be helpful in understanding if career or employment setting transitions occur due to age or life changes.
Giacobbi PR Jr17 Survey 934 (454 male, 480 female) certified AT's Occupational settings (collegiate =293, secondary school =276, clinical/industrial =365) **Age =33.84 ± 8.29 years Stress Appraisal Measure (SAM) Maslach Burnout Inventory (MBI) Occupational Engagement Survey (OES) Symptom Checklist (SCL-90R) Leisure-Time Exercise Questionnaire (LTEQ) * Stress was moderately associated with depersonalization (r=0.30), emotional exhaustion (r=0.46), and somatic health complaints (r=0.33). *Vigor was negatively related to depersonalization (r= −0.27), and emotional exhaustion (r= −0.33). *Somatic health complaints were moderately associated with depersonalization (r= 0.27) and emotional exhaustion (r= 0.44) *Exercise behavior was positively associated with vigor (r=0.15) and personal accomplishment (r=0.18). Continue to examine burnout within the AT profession as well as preventative programs for females and AT's employed in settings where the burnout rate is highest.
Goodman A, et al.28 Qualitative 23 female AT's Semi-structured interviews Reasons for current SEC AT's to remain in division I setting: (6)reported enjoying job/fitting division I mold, (2)due to increased autonomy, (2)due to positive athlete dynamics, (1)due to kinship responsibility, and 1 due to social support network. Factors contributing to females leaving SEC institution: (4)reported life balance issues, (2)due to supervisory/coach conflict, (2)due to kinship responsibility, (1)due to role overload, and (1)due to role conflict. Need for NATA and NCAA institutions to develop retention programs for combatting life balance, role conflict, role overload. Additional studies needed to investigate attrition/employee turnover and strategies to improve job satisfaction. Former and currently employed male AT's indivision I conferences and administrators should be investigated to obtain and compare experiences/views of retention and attrition.
Hendrix AE, et al.16 Cross-sectional 118 NCAA Division I-A ATC's **Age of football AT's= 38.7 years **Age for non-football AT's=31 years Demographics survey The Hardiness Test Social Support Questionnaire (SSQ) Athletic Training Issues Survey (ATIS) Perceived Stress Scale (PSS) Maslach Burnout Inventory (MBI) ** Football AT's: hardiness test=94.4, PSS=24.6, MBI: emotional exhaustion=20.24, depersonalization=10.93, personal accomplishment=37.15**Non-football AT's mean scores: hardiness test=94.3, PSS=23.8, MBI: emotional exhaustion=20.06, depersonalization=8.44, personal accomplishment=38.82 Continue investigation of physiological symptoms to determine stages of burnout among AT's. Need to explore potential stressor variables in AT's at non division 1 universities. Sex differences should be investigated in AT's in all sports. Longitudinal studies needed to determine differences in burnout in AT's across sport seasons.
Kania ML, et al.11 Cross-sectional survey 206 (male=108, female=98) NCAA AT's **Age= 32.7 ±8.7 years Demographics survey Maslach Burnout Inventory-Human Services Survey (MBI-HSS) MBI-HSS: ** Level of emotional exhaustion= 18.1 ±9.9**Level of depersonalization= 6.7±4.9**Level of personal accomplishment= 93.9±5.8 Perform longitudinal studies examining fluctuations in burnout symptoms during the course of an academic year. A new or updated burnout assessment tool that is more sensitive to workplace stressors would be valuable to the AT profession. Examine suggested preventative measures for burnout in order to communicate interventions to the AT profession.
Mazerolle SM, et al.27 Qualitative 8 male Division 1 AT's (100% married with 6 AT's having children) **Years of NCAA division I experience=15 ± 11**Hours worked/week during sport season=66 ± 5 hours **Age=45 ±11 years Semi-structured interviews Male AT's reported reasons for role strain, role transition, and work family conflict, and difficulty achieving work-life balance. Need to further investigate reasons males leave other occupational settings (i.e. division II, III, secondary schools). Future research should also explore reasons male AT's who are not married and/or do not have children leave the current practice setting.
Mazerolle SM, et al.24 Qualitative 28 division I football AT's (men=13, women=15) **Years certified=12±8**Age=35±9 years **Hours worked/week in season= 64±16**Hours worked/week off season=45±11 Electronic interviews with follow up interviews via phone Demands of the profession create difficulty to make new connections with individuals outside the work environment, chaos, fatigue, and hard to manage time. Lack of flexibility in work schedules was the primary source of conflict with managing personal responsibilities. Lack of staffing/resources affects work-life conflict, and overall quality of life. Organizational policies can help offset work load between colleagues and promote work-life balance. Family integration and support from family aids in managing life balance. Continued investigation of family integration into the work environment, and organizational/individual policies for promoting work-life balance in non-traditional settings is required. Future studies should also focus on work-life conflict in more selective samples within the division I football setting, and explore the outcome of utilizing life balance strategies within the division I football setting as well as other non-traditional work settings. NATA should explore ways to enforce the recommendations of the task force to establish appropriate medical coverage for collegiate institutions.
Mazerolle SM, et al.19 Cross-sectional 246 AT's of varying family and marital status 5-item work-family conflict scale 3-item work-leave benefits scale Single question addressing willingness to leave the profession ** WFC scores: males = 17.03±4.47, females = 16.76±4.36**WFC scores by clinical setting: collegiate = 18.52±3.70, secondary school = 17.20±4.09**Willingness to leave the profession: males = 3.14±1.06, females = 3.31±1.04**Willingness to leave the profession by clinical setting: collegiate = 3.21±1.05, secondary school =3.13±1.00 Explore WFC and strategies to improve work-life balance such as gaining perspectives from individuals providing support. The 3-item work-benefits scale and the single question regarding willingness to leave the profession should be evaluated to use in combination. An instrument investigating comfort with and use of specific work-family workplace policies will be helpful in narrowing which facets of work-leave benefits influence balance or willingness to leave the profession.
Naugle KE, et al.12 Cross-sectional 390 District 9 AT's (232 males, 158 females) **Male age = 38.71±10.10 years **Female age = 32.41±7.09 Copenhagen Burnout Inventory (CBI) Perceived Wellness Survey (PWS Baecke Physical Activity Questionnaire (BPAQ) Males total scales of PWS, CBI, and BPAQ: **Hours/week worked=60±26.04** Perceived wellness =16.69±2.77**Burnout = 38.73±16.90**Physical activity = 8.42±1.32Females total scales of PWS, CBI, and BPAQ: **Hours/week worked = 47.86±20.57** Perceived wellness = 16.41±2.81 **Burnout =46.20±17.18**Physical activity = 8.77±1.36 Continue to investigate job retention in relation to hours worked and burnout rates in female AT's. Seek to improve understanding of burnout in relation to sex and personality, wellness, and activity levels Investigate family environments in relation to sex and personality, wellness, and activity levels.
Pitney WA, et al.8 Sequential explanatory mixed-methods 415 NATA members employed in secondary school (203 women, 212 men, 65.1% married, 21.7% single, 55.7% have children, 44.1% without children) **Age = 36.8±9.3 years Two 5-item scales relating to one's perceived level of work family conflict Phase I WFC scores scale 1: **Overall = 23.97±7.78**Women = 23.59±7.69**Men = 24.25±7.85**With children = 24.5±7.7**Without children = 22.91±7.8Phase IWFC scores scale 2: **Overall = 23.17±7.69**Women = 22.67±7.52**Men = 23.63±7.82**With children = 23.6±7.71**Without children = 22.58±7.66 Examine differences in WFC between AT's employed in secondary schools and clinic/outreach positions. Perform longitudinal studies to monitor changes in WFC as years of experience increase and/or alterations in family situations occur.

Coping Strategies for Managing and Preventing Burnout among Collegiate and Secondary School Athletic Trainers

Author(s) Study Design Participant Demographics Outcome Instrument Results Study Implications
Mazerolle SM, et al.24 Qualitative 28 division I football AT's (men=13, women=15) **Years certified=12±8 **Age=35±9 years **Hours worked/week in season= 64±16 **Hours worked/week off season=45±11 Electronic interviews with follow up interviews via phone Demands of the profession create difficulty to make new connections with individuals outside the work environment, chaos, fatigue, and hard to manage time. Lack of flexibility in work schedules was the primary source of conflict with managing personal responsibilities. Lack of staffing/resources affects work-life conflict, and overall quality of life. Organizational policies can help offset work load between colleagues and promote work-life balance. Family integration and support from family aids in managing life balance. Continued investigation of family integration into the work environment, and organizational/individual policies for promoting work-life balance in non-traditional settings is required. Future studies should also focus on work-life conflict in more selective samples within the division I football setting, and explore the outcome of utilizing life balance strategies within the division I football setting as well as other non-traditional work settings. NATA should explore ways to enforce the recommendations of the task force to establish appropriate medical coverage for collegiate institutions.
Mazerolle SM, et al.23 Systematic review Male and female AT's with varying family situations, roles, and ages employed in various settings Phone interviews and surveys AT's in all employment settings learned to implement various strategies in their personal and professional life to achieve life balance. AT's in clinic/outreach positions achieved work-life balance through set working hours and scheduling flexibility. Secondary school and collegiate AT's found family integration into the work environment helped achieve work-life balance. Future research should explore work-life balance strategies in other levels of collegiate institutions, male AT's with children, and single or married AT's without children. Investigate personality types to determine whether or not it affects an AT's ability to balance work and life.
Mazerolle SM and Bruening JE30 Qualitative 12 AT's employed at NCAA division I universities Interviews AT's gave an account for prioritizing personal and family time, improving locus of control, and securing adequate medical coverage. Evaluate the effectiveness of implementing work-life balance strategies outlined in this study.
Authors

From the Athletic Training Program (SJC, TCVM) and the School of Osteopathic Medicine (TCVM), A.T. Still University, Mesa, Arizona.

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Tamara C. Valovich McLeod, PhD, ATC, FNATA, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206. E-mail: tmcleod@atsu.edu

Received: June 13, 2018
Accepted: April 03, 2019
Posted Online: July 26, 2019

10.3928/19425864-20190529-01

Sign up to receive

Journal E-contents