The health and well-being of patients is a primary concern for athletic trainers that often stimulates them to place the needs of their patients ahead of their own. During the past few years, there has been a growing concern related to the well-being of athletic trainers because it has been reported that athletic trainers experience a reduction in job satisfaction and professional/organizational commitment,1,2 work–life imbalance,1 and job burnout.2,3 Professional/organizational commitment, work–life balance, and job satisfaction and burnout are distinctive concepts, but they are intertwined by their inhibitors and facilitators; therefore, in many cases, one may not be discussed without the other.4,5 These professional issues are concerning because they not only negatively affect the athletic trainer personally, but they may also influence the quality of care that athletic trainers are able to provide to their patients.6
The role an athletic trainer plays in health care can be emotionally intense and often requires working long hours, managing7 high patient–clinician ratios, and competing roles within the workplace.8 The nature of the role and expectations of athletic trainers in the workplace can negatively affect their own health and well-being5 unless they are able to identify the increased stress that they face when dealing with these concerns and develop effective strategies to reduce the negative effects.
As a profession, athletic trainers dedicate time, energy, and their resources to care for others, but it is also important for them to value their own health and emotional well-being. In fact, attention to mental and emotional well-being can positively affect athletic trainers regarding their job and life satisfaction, which can stimulate and support personal and professional longevity. Although scarce, the literature3,9,10 indicates that athletic trainers do not engage in self-care. Furthermore, a greater portion of athletic trainers do not meet the standards outlined by the American College of Sports Medicine regarding physical activity and consuming a balanced diet.9 Groth et al.9 classified the healthy behaviors of their sample as not meeting the professional recommendations of the American College of Sports Medicine. Barriers to meeting the guidelines are often linked to the same contributing factors of work–life imbalance, job dissatisfaction, job burnout, and reduced professional commitment. This is another example of the importance of discussing ways in which athletic trainers can engage in healthy habits that can improve their health and well-being.
In this review, four constructs that are related and critical to the well-being of athletic trainers are discussed: job satisfaction, work–life balance, job burnout, and professional and organizational commitment. The purpose of the current review was to highlight these four professional constructs, particularly regarding what defines each construct, the relationship between each, and their effect on the health and well-being of athletic trainers (Figure 1) Additionally, recommendations to help create job satisfaction, professional/organizational commitment, and work–life balance, and to reduce job burnout are provided. Our recommendations are reflective of the relevant literature in athletic training, health care, and sport and are presented from a top-down and bottom-up perspective. These recommendations reflect the need for organizations to have strategies to help athletic trainers and for athletic trainers to demonstrate accountability and proactivity in their own health and well-being.
Relationship between professional issues and health and well-being.
Job satisfaction has been defined as the degree to which individuals like their jobs.11 However, this simplistic definition of job satisfaction does not describe how or why an individual may be satisfied with his or her job. Job satisfaction is a highly complex construct involving numerous components, which creates a fundamental problem when examining the construct.12 Despite the complexity of job satisfaction as a construct, the literature is saturated with examinations of job satisfaction and its related factors.11,13–20 McKenna21 suggested that an individual's attitude toward how well personal expectations matched actual outcomes was a more robust definition, although this too only described the components of job satisfaction. More comprehensive definitions should involve a combination of affective and cognitive reactions to what an individual employee wants to receive compared to what is actually provided by his or her job and organization.22
The nature of individual professions is what influences the degree of satisfaction. An employee's job satisfaction may be affected in a positive or negative way based on numerous factors. For example, employer feedback delivered in a prompt manner tends to increase job satisfaction,23 whereas work–life conflict tends to decrease job satisfaction.24 Workplace support has a positive influence on job satisfaction and can serve as a buffer to counteract the negative effect of burnout on job satisfaction.25 Other factors such as salary have been shown to have either a perceived negative26 or positive27 influence on employee job satisfaction. It is important to remember that the effect of any one of these factors may only marginally influence job satisfaction.
The abundance of literature11–20,23,25–27 related to job satisfaction is likely due to the relationships between job satisfaction and personal and work variables. These variables can be categorized broadly into four groups28: personal characteristics such as age, gender, and education; work environment or conditions such as workload, autonomy, organizational justice, and role conflict; work incentives such as salary, opportunity for advancement, and bonuses; and interpersonal relationships at work such as quality of supervisors and working relationships with colleagues. These factors represent both organizational- and individual-level factors and highlight the multifactorial nature of job satisfaction. A meta-analysis within nursing focused on three of these factors: work incentives, which they termed economic; work environment, which they termed structural; and interpersonal relationships, which they termed psychological.29 Of these variables, work content and environment had a stronger influence on the job satisfaction of nurses than economic or individual variables.29 This means that regardless of gender or other individual level factors, nurses' salaries affected their job satisfaction less than their work environment or responsibilities and, therefore, personal characteristics was not included in the model.29
Job satisfaction is a well-documented facilitator of organizational and professional commitment,30,31 especially in the nursing and health care fields. Job satisfaction has been shown to be the main predictor of intentions to leave a profession or organization.12,32 An individual with higher job satisfaction is less likely to leave a profession compared to an individual with lower job satisfaction.32 Terranova and Henning33 found a strong negative correlation between various facets of job satisfaction and intentions to leave athletic training. Job satisfaction has been shown to have a strong relationship with life satisfaction, although this relationship does weaken with longitudinal data.34
In general, individuals who are satisfied with their jobs are happier both mentally35 and physically.36 However, the literature is not clear on whether job satisfaction facilitates health or vice versa. Peterson and Dunnagan15 found that demographic variables were better able to determine job satisfaction than health behaviors, signifying that job satisfaction promotes health but healthy behaviors do not automatically promote job satisfaction. Additionally, the literature on work-related stress has linked job satisfaction and stress outcomes.37 Research has shown that the level of work environment dissatisfaction significantly predicts the degree of overall stress experienced by employees.38 Individual stress and dissatisfaction at work can become the catalysts for negative health outcomes.39 High perceptions of stress have been associated with less frequent exercise, higher fat diets, and more cigarette smoking.40
The improvement of job satisfaction for athletic trainers should focus on strategies that can reduce stress in the workplace and positively spill over into their personal lives. For example, improving the salaries of athletic trainers, including the benefits they receive, can directly affect their job satisfaction and ability to provide for their families.26,27
Valuing employees as stakeholders within an organization can foster satisfaction in the workplace. This can be accomplished by offering mentoring relationships and recognition for exceptional job performance.41–43 Work-place relationships between coworkers and supervisors are also important and directly relate to job satisfaction. Therefore, collegiality and teamwork should be promoted and encouraged because they can stimulate support networks.23,25,28 Self-reflection, goal setting, and professional development30,31 are key for the individual athletic trainer and fulfillment of job satisfaction. Having goals and the support to pursue them professionally and personally can help create fulfillment and satisfaction.30,31
Work–life balance is a multifactorial construct that reflects an individual's ability to effectively manage his or her paid occupation with his or her personal activities and responsibilities that are deemed important.44 Although work–life balance is a growing concern among all working professionals, health care providers and athletic trainers are susceptible to a reduced work–life balance due to their demanding roles.1,5,45–48 The growing interest in work–life balance among athletic trainers is founded on the relationship it has with reduced professional commitment and turnover.1,5,49
Research suggests that a reduced work–life balance occurs due to several variables: organizational, individual, and sociocultural (Figure 2).44,50–52 Organizational variables, which are those that characterize the work-place, include long work hours, travel, autonomy over work schedules, and large patient-care needs that lead to role strain and overload. For athletic trainers, long work hours (40+) and the expectation to be “present” can limit time available for non-work interests or family obligations and responsibilities,1,3,5,53 which is the primary catalyst to a reduced work–life balance. Although a reduced work–life balance has been reported across clinical settings, the college and professional sports settings appear to experience heightened conflict due to their professional demands.1,3
Work–life balance contributors.
Individually speaking, females tend to report greater conflict due to their attempts to provide equal investment in domestic, parenting, and working roles.54 In a recent study,55 we found that female athletic trainers face the challenge of “mom guilt” because they try to be vested fully as a mom, wife, and athletic trainer. Also, from an individualistic perspective, wanting a more adaptive lifestyle (balance among all roles) has been associated with fulfillment of work–life balance.56 Athletic trainers also display a selfless mindset and place their patients' needs over their own, which can stimulate a reduced amount of time available for personal interests.56 From a sociocultural standpoint, women often place a greater emphasis on domestic and parenting responsibilities because they believe it is expected of them; thus, they can perceive greater challenges in creating a work–life balance.43 Female athletic trainers have shared struggles with work–life balance, and in some cases working less hours than male athletic trainers, likely as a result of the pressures to complete domestic and parenting duties.3,54,55 Interestingly, work–life balance correlated more positively to both job and life satisfaction and more negatively to anxiety in individuals living in gender egalitarian cultures.57
Much like the barriers, strategies used to facilitate a work–life balance are rooted in organizational and individual factors. Time management and priorities are critical and athletic trainers must identify daily responsibilities of personal and professional inflection that need to be completed.58 Improving work–life balance will have a direct effect on the health and well-being of the athletic trainer because satisfaction in all aspects of life is often observed when harmony exists.24
Work–life balance can be maintained by taking advantage of informal and formal work–life balance policies offered within the workplace (Table 1). Formal policies that are gender-, marital-, and parent-neutral and address the work–life balance needs of athletic trainers must be developed to address the uniqueness of the work setting. Examples of such policies include medical care policies, hours of operation, sick/paid time off, and child-care assistance.58–60 Informal work–life balance strategies are considered a cultural norm in the workplace and are fostered by the collegiality between coworkers and supervisors regarding work–life balance fulfillment. Demonstrating flexibility and creativity when supporting the athletic trainer's work–life balance needs is often the informal method used in athletic training. The shift in a mindset to medical care versus coverage can assist in the workload of the athletic trainer and can be adopted to support balance.54,58 Supervisors can facilitate job autonomy for athletic trainers by allowing them to manage their schedules and address their own professional and personal needs.41,61 Communication between the individual and the supervisor can facilitate this process efficiently.
Strategies for Work–Life Balance
Athletic trainers need to take time away from their jobs and create separation and boundaries between job and family life because this can allow for a renewed sense of passion and commitment for each role.45–48,54,58 This mindset will require letting go of the ideology that only the individual athletic trainer can provide medical coverage to a student-athlete or patient. Borrowing from the concept of hospitals or physicians' offices, credentialed medical and health care providers can be suitable in situations in which personal matters are important.47,48 It is important for the athletic trainer to develop support networks at home and in the work-place54,58,61 and to not be afraid to delegate or ask for help to improve work–life balance. This can include outsourcing tasks in the homestead such as grocery shopping, lawn care, or housekeeping. Recommendations for outsourcing domestic and household chores have emerged as ways to achieve a better work–life balance when financially feasible. In the workplace, examples of delegation of tasks can include rotating morning treatment coverage and job sharing (ie, providing medical coverage for coworkers so they can leave early).57 Being proactive with personal and professional needs through communicating goals and needs (ie, attending conferences for professional growth or taking a day off to attend a friend's wedding) can directly improve work–life balance because it improves locus of control over work scheduling.54,58 Demonstrating a commitment to one's own personal goals is just as important as performing in one's professional roles.61
As health care providers, athletic trainers spend a large portion of their workdays caring for student-athletes and patients and can often be described as selfless individuals. However, this characteristic, which makes the athletic trainer a unique health care provider, can place a great strain on the athletic trainers themselves. Furthermore, the work environment of athletic trainers is often demanding and intense,62 thereby leaving them susceptible to experience prolonged stress, which is a precursor to job burnout. Despite reports indicating that working as an athletic trainer can provide great personal and professional rewards, the reliance that student-athletes and patients can have on their athletic trainers has the potential to stimulate the occurrence of job burnout.3,63 It has been reported that 32% of athletic trainers experience moderate burnout64 and, despite some limitations to the data, other studies published thereafter continue to document athletic trainers' struggles with job burnout.3,63,65
Job burnout is a response to chronic stress, which leads to emotional and physical exhaustion and eventual disinterest and lack of motivation for one's job.66 A concern for any working professional, and especially for a health care provider, burnout can result in a reduction in the quality of care provided to the student-athlete or patient. Burnout has been reported within athletic training,3,63,65 with factors such as long working hours, high workloads (ie, number of patients), conflict in the workplace, years of experience, and ineffective coping skills as catalysts for job burnout.67 In addition to these variables, sex has also been linked to experiences of burnout in athletic training and other health care professions, where females report higher levels of burnout.4Table 2 presents factors that have been associated with job burnout in athletic training, either as a contributor to its occurrence or a factor in reducing its occurrence.
Job Burnout in Athletic Training
Strategies suggested to reduce and prevent job burn-out are founded on recognizing its development and symptoms associated with the condition. First and foremost, job burnout manifests when the athletic trainer is overworked and has little time to rejuvenate. Therefore, when feelings of being overwhelmed and overextended are not attended to, burnout is likely. Athletic trainers who are exhibiting signs of burnout will be cynical, lack energy, passion, and engagement in their colleagues and patients, and will often notice changes in their normal patterns (ie, eating or sleeping).68 Job burnout manifests within an individual who is overworked and unable to implement strategies to reduce it.68 Supervisors can play an important role in reducing burnout because they can help mediate workloads and demands placed on their staff members. Thus, supervisors are encouraged to assess each staff member's workload to ensure that it is reasonable and equitable. Workloads are reflective of several aspects, including hours worked, number of patients, and other duties that require time to complete.7,62–64 Supervisors can also reward their staff by acknowledging hard work or the need for time off.62 This can be achieved simply by saying “thank you” for a job done well or providing athletic trainers with a day off as a reward for their dedication. Finally, job engagement and locus of control should be considered within the workplace as ways to directly reduce the chance for burnout. Clear expectations, opportunities for growth through involvement in various roles and feedback on performance, and chances to make contributions to the organization are ways to stimulate the athletic trainer in the workplace.7,69
Athletic trainers should be sure to invest in themselves, which includes eating right, exercising, and sleeping.9 Self-care is critical in reducing stress, which is the primary catalyst for burnout. It is also important to have a clear understanding of one's role within the organization, which helps to avoid uncertainty and undue stress. Athletic trainers should be sure to ask what is expected of them and continue to seek feedback related to job performance to perform at the highest level and grow in the organization.7,69 Mindset is key, so the athletic trainer should be open and adaptable.70 It is important for the athletic trainer to recognize when the workload is high or becoming unmanageable and then take the steps to reduce the workload. Often, asking for help or seeking support from peers and coworkers can be of assistance.71
Professional and Organizational Commitment
Commitment is a state of being dedicated. A primary underpinning to organizational and professional commitment is the attachment and loyalty one can feel toward his or her professional trade. Therefore, when commitment is reduced, the individual can be at risk for increased emotional stress, which will negatively affect the health and well-being of the person. Although similar, professional and organizational commitments are different in their focus of dedication.
Organizational commitment is the relative strength of an individual's involvement and identification with an organization.72 Organizational commitment has been operationally defined as a combination of three distinct factors: acceptance of and strong belief in the organization's goals and values, desire to work hard for the organization, and desire to remain working in the organization.73 Organizationally committed individuals are more satisfied and their commitment plays a role in stability, innovation, and achievement of goals within an organization.72 Organizational justice, perceived growth and personal development, job security, job task variety, degree of autonomy, feedback and recognition of work, personal identification with job tasks, and job satisfaction have all been shown to enhance organizational commitment.72 Additionally, individuals with higher organizational commitment have lower intentions to leave.72
Conversely, professional commitment is commonly described as the strength of an individual's identification with and participation in a profession.74 Professional commitment relates to an individual's loyalty and obligation to their profession. Professional commitment can reflect a positive or negative attitude toward a profession and may be affected by many different factors, including age, gender, years of experience, opportunities to become integrated, previous experiences, and work-place characteristics containing engaging and collegial relationships.75–77 Meyer et al.78 defined three individual categories of professional commitment: affective, continuance, and normative. Affective professional commitment represents identifying with a profession and being loyal and psychologically attached. Continuance professional commitment signifies the apparent costs associated with leaving the profession. Normative professional commitment indicates a moral obligation to the profession. All three components have implications for individuals remaining with or leaving their profession. Professional commitment has emerged as a leading focus for scholars because the connection has been made between a professional's level of commitment and retention within his or her field.75,78,79
Within athletic training, Pitney80 found that professional commitment in secondary school athletic trainers was influenced by both intrinsic and extrinsic rewards and respect from others. In the collegiate setting, professional commitment was found to be positively influenced by coworker support, dedication to advancing the profession, ardor for job responsibilities, a commitment to the student-athlete, and education.81 Conversely, human resources, life stage, work overload, and organizational climate were all found to be barriers of professional commitment for athletic trainers employed in the collegiate setting.82
Scholars identified a connection between employees' level of commitment and retention within their field75,78,79: individuals who exhibit commitment for the profession they are employed in are more likely to remain dependable and exhibit higher job outcome performances.74,83 Recent literature has suggested that factors such as job satisfaction, work–life balance, and burnout can negatively affect an athletic trainer's perceptions of longevity5 and lead to departure,84 essentially influencing professional commitment and subsequent professional retention. Commitment to the organization and profession can be supported by engagement and promoting continuing education. Therefore, employers are encouraged to offer continuing education reimbursement for employees to enhance innovation and support the athletic trainer's commitment to education and life-long learning.80 It not only demonstrates a supportive workplace, but also allows for advancement of the athletic trainer's skills and knowledge base. Employers should foster job awareness, which can be achieved by providing clear and detailed job descriptions for their employees. This can help athletic trainers relate their roles within the workplace back to organizational goals so that employees can see the value in the tasks they are completing.72 Feedback that is constructive and positive from supervisors can help with maintenance of professional commitment, especially when it is timely and relevant, because it allows for the understanding of performance and contributions to the goals and mission of the organization.80 Self-reflection can foster professional and organizational commitment. Although it is normal to become stressed, athletic trainers should try to focus on the things that they love about athletic training and remind themselves why they chose the profession to begin with.80
Job satisfaction, work–life balance, burnout, and organizational and professional commitment are directly influenced by one another, yet are distinctive constructs85 that have the potential to affect the health and well-being of athletic trainers.35,36,39,68 Health and well-being are often viewed as important roles that athletic trainers play in the health care setting as they care for their patients. In athletic training, professional performance is often centered around delivery of patient care and patient outcomes. As discussed in the current review, job dissatisfaction, burnout, work–life conflict, and a lack of professional commitment are all individual catalysts for poor job outcome performances. These factors also influence an athletic trainer's career intentions and negatively affect professional retention. Although there are a few positive benefits to occupational or organizational turnover (change and progress, avoidance of “group think,” and an opportunity to broaden the base of knowledge),86 the negative consequences will certainly affect patient care. Negative consequences include elimination of positions, an increased workload for remaining staff, worker shortages, financial difficulties, and potential turnover of other employees.86
The purpose of this review was to stress the importance of athletic trainers making their own health and well-being a priority because we believe it can positively influence the quality of care that they provide to their patients. It is essential that future research examine the correlation between athletic trainer health and well-being and patient care.
Much of what we discuss in patient outcomes is anecdotal. Although there is a clear link between the constructs discussed here, turnover, and clinician health and well-being, we need to learn more about the effect on our patients. To aid our point, the analogy of the flight attendant's instructions can be used: “in the case of an emergency, please place the oxygen mask over your mouth, and then assist your child.” Simply, we must care for ourselves to provide the best possible care to our patients.
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Strategies for Work–Life Balance
|Formal Work–Life Balance Policies||Informal Work–Life Balance Policies|
|Work time arrangements (when and where work is completed)||Supervisor who is supportive of work–life balance|
|Workplace integration||Supervisor who models work–life balance|
|Maternity and paternity leave||Coworkers who are supportive and engage in sharing the responsibility in the work setting|
|Sick and paid time off||Shared values regarding work–life balance among athletic training staff members|
Job Burnout in Athletic Training
|Strategies to Prevent Burnout||Catalysts for Burnout|
|Effective coping strategies (being resilient)||Work hours (+60 hours per week)|
|Emotional stability and hardiness||Large patient or workloads|
|Strong social support networks||Role ambiguity|
|Job engagement (feeling empowered)||Work environment (stressful, demanding)|
|Taking care of oneself (eating, sleeping, etc.)||Lack of control over work schedules|
|Sex (higher levels reported in females)|