A Qualitative Examination of Professional Role Commitment Among Athletic Trainers Working in the Secondary School Setting

Health care providers are expected to offer quality care at all times. However, the demands of the work environment can present challenges to athletic trainers (ATs) providing care. For example, many ATs may be in roles requiring them to deal with multiple responsibilities (eg, teaching and patient care),1 limited resources, and high patient volume.2 These multiple responsibilities may challenge an AT's motivation and commitment for an extended period throughout his or her career3 and lead to negative consequences related to fulfilling a professional role in an organizational setting.

Several groups have addressed the negative consequences for ATs resulting from navigating the demands and expectations of their role, such as burnout,4 role strain,1,5 and work-family conflict,6,7 which can compromise a practitioner's ability to effectively perform his or her role and develop professionally. Only recently, however, have we gained an understanding of the positive aspects of the athletic training work setting and how individuals maintain a commitment to their professional role, despite working in challenging organizational environments.3 

Limited research on commitment exists in the context of athletic training, although one previous author8 has provided insight about professional commitment within the intercollegiate organization. Winterstein8 revealed that ATs were committed to both the intercollegiate student-athlete and the athletic training student. Although Winterstein's study contributes to our understanding of commitment in the intercollegiate context, a paucity of information exists about the contextual influences that allow an AT to maintain the commitment to one's professional role within the secondary school environment.

The purpose of this study, therefore, was 2-fold: first, to explore how ATs working in the high school setting perceived the phenomenon of professional commitment; and second, to understand how these individuals maintained their commitment in spite of working in professionally challenging environments. The following central research questions guided this study:

1. How do ATs working in the high school setting perceive professional commitment?

2. What influences ATs to maintain their commitment over the course of their career?

In this exploratory study, I sought to understand ATs' perceptions related to a specific phenomenon. Thus, a qualitative method was used to addresses the exploratory purpose and research questions.9,10 The study was approved by the Northern Illinois University Institutional Review Board before data collection.

A criterion sampling strategy was used: participants worked in the high school setting, had a minimum of 10 years of experience as a Board of Certification-certified AT, and self-identified as having maintained their professional commitment. Ten years of experience was selected to ensure that the participants were beyond a period of role inductance and well into role continuance. Seventeen individuals (14 men, 3 women) with a mean age of 44.3 ± 6.8 years and 19.0 ± 6.7 years of experience as an AT participated in the study. Volunteers were from National Athletic Trainers' Association (NATA) Districts 1 though 6. Table 1 summarizes the participant demographic information. Table 2 presents individual data using participant pseudonyms.

The NATA member services database was used to identify potential participants by sorting the database and selecting individuals who 1) worked in the high school setting and 2) had been certified members of the NATA for at least 10 years. Once the NATA member database was sorted, 1000 individuals meeting the above criteria were randomly selected and invited via e-mail to participate. The letters explained the nature of the study and asked for participation by individuals who believed they had maintained a level of professional commitment and enthusiasm in their roles as ATs. Individuals who replied and expressed an interest in participating were sent a demographic data sheet and informed consent form via standard mail. On the demographic data sheet, individuals indicated when they could be contacted for a formal interview.

Once the informed consent form and demographic data sheets were obtained, I contacted participants to schedule and conduct a phone interview. Phone interviews used a semistructured interview guide (see  Appendix) and lasted approximately 30 to 85 minutes each. The interview guide was based on the work of Poczwardowski et al,11 who studied commitment and reinvestment strategies of health educators. The phone interviews were either digitally or audiotape recorded and transcribed verbatim. Data were collected until saturation of data was achieved.12 Data saturation occurred after 13 interviews, but additional data were collected to confirm the findings.

The study used a basic, interpretive qualitative design,12,13 although I borrowed from the phenomenologic tradition to gain an understanding of the essence of commitment from the perceptions of the participants.14 As a researcher, my presupposition about professional roles and one's subsequent commitment (or lack thereof) is that a reciprocal relationship exists between one's social experiences and his or her conscious processes. Thus, an individual's perceptions of commitment are likely borne from his or her experiences with others in an organizational setting. To prevent researcher bias, I engaged in a process of epoch, or bracketing, which is consistent with the phenomenologic method. To complete this exercise, I identified all of my personal beliefs regarding and experiences with professional role commitment and articulated them in writing. Once identified, I could recognize if they entered into or biased the analysis of data.

The data analysis involved the following steps: 1) reading each transcript in its entirety to gain a sense of the participant's perceptions and holistic experience, 2) identifying and coding significant pieces of information or phrases (meaning units) from each transcript, 3) arranging the meaning units into clusters of themes, and 4) conducting verification procedures with participants. To construct a theme, I stipulated that meaning units had to be offered by at least 50% of the study's participants, a procedure similar to that used by authors15 of another qualitative study. This strategy was used to ensure that emergent themes were robust. In total for this study, data from no less than 70% of the participants were used to construct each theme.

Member checks12 were performed to verify the findings that emerged from the analysis. Seven of the 17 participants were randomly selected to discuss the results and ensure that the findings were reasonable based on their experiences. Random selection was used at this point because time constraints prohibited contacting all participants. The member check process involved a dialogue that both reviewed the study findings and further explored the emergent themes. During this follow-up interview, each theme was described to the participant, who was asked to comment on these findings and articulate if the finding was reasonable based on his or her experiences and perceptions. The emergent themes were verified and supported by the participants.

A peer debriefing process was also used to ensure trustworthiness of the findings. The peer debriefer was formally trained in qualitative research and had published peer-reviewed qualitative research studies. The peer debriefer identified that the data were collected and analyzed in a logical and systematic way but also provided advice as to how to present the thematic titles to better reflect the data that was collected. One potentially biased question was identified and data emerging from that question were not subsequently used in the analysis.

Four themes emerged from the findings that explained the participants' perceptions of, and experience with, maintaining professional commitment. The emergent themes were 1) professional responsibility, 2) rewards, 3) respect, and 4) rejuvenation. Each of these themes is explained below and supported with participants' quotes. Pseudonyms are used to protect the participants' identities.

Participants explained that a strong sense of responsibility to their patients was a prominent aspect of their perception of professional commitment. Tom, for example, explained that “professional commitment means … you have to be able to administer responsible treatment to your patients … the patient's concern is always number one.” This was echoed by Lon, who articulated what he is committed to: “I'm committed to … all athletes to maintain and offer up a quality of care that's going to positively affect any kind of situation that occurs here.”

Participants articulated a responsibility not only to their patients but also to the role of the professional in maintaining competence. For example, John stated:

For Bill, an AT with additional teaching responsibilities, his commitment was to his students as well as to his professional role as both an AT and educator. He stated, “I think my professional commitment overall is on a broader scale than most ATs who are sort of in that [athletic] training room environment day in and day out. I think I'm in a little different situation that gives me a commitment to my profession on a broader scale.”

The emergent theme of professional responsibility reflected attention to the patient. The AT's sense of commitment and ability to maintain it was influenced by the work setting. The remaining emergent themes of rewards, respect, and rejuvenation explain how the work setting influenced the ability of ATs to maintain commitment.

The participants discussed how the rewards they received contributed to maintaining their commitment. All of the individuals identified intrinsic derived rewards, such as feeling appreciated and valued and enjoying one's role. The respondents stated that these rewards were provided by a simple “thank you” or acknowledgment from athletes, parents, or coaches. Indeed, such rewards were commonly expressed as determinants of professional commitment. When asked what helped him maintain a high level of professional commitment, Hank stated, “You know [the role] is tough. I enjoy the high school level. I enjoy the kids there … and the parents at this level are very, very thankful because there are few ATs [at the schools] at least out in our area. So when the parents and the kids themselves are very appreciative of your work, it makes you want to strive a little bit harder too.”

Ron corroborated this sentiment when he articulated that the show of appreciation is a substantial reward for him: “Well, I think it's just simply the ‘thanks’ … parents being appreciative, athletes being appreciative and respectful … When a senior comes back and shakes your hand, or hugs you, or whatever … those are the things you do the job for!”

From an intrinsic reward perspective, Lon articulated such comments as “[Your commitment has] got to be internal to a certain degree. Yes … as I said it's nice to get those little external or extrinsic things, whatever you want to call them—materialistic things or just something—but also, too, [commitment] has got come from inside.” Another participant, Richard, articulated his intrinsic reward very concisely when he stated, “I enjoy what I do, and I always have. I know that I provide a useful service to the student-athletes that I serve on a daily basis. This intrinsic fact of self-fulfillment is probably what keeps me going after 33 years on the job. I know that when I retire in a few years, this personal contact on a daily basis will be what I will miss the most.”

Participants, however, also identified other forms of rewards, such as those that are extrinsic in nature, for example, monetary compensation and scheduling adaptations, as being significant factors in maintaining their commitment. Lon, when asked about maintaining commitment and a life balance, explained how extrinsic rewards played a role: “I think I'm blessed with the fact that I've got such a well-paying job with very good benefits. So that makes it easier to say ‘okay, I can put in this time.’ I'm being well compensated for my time.”

Donald stated, “… [the job] has its ups and downs. I mean I'm not saying my job is perfect, but I'm at a great place. [It] pays well [and] that, I think, helped me maintain my professional commitment … I do make a better than average AT income at the school …”

Apart from financial reward, many organizations allowed the ATs to develop flexible schedules, in which they could begin work later in the morning on days when they had to work into the evening. Schedule modifications such as this by the administration were viewed as an extrinsic reward for being committed to the athletic training role and having a strong work ethic.

Perceiving a level of respect from others was also a determinant of professional commitment and staying invested in one's role. Receiving respect from others associated with the organization depended on displaying adequate competence and communicating one's value. As an example, John discussed how his role improved when he displayed the value of his role:

In this instance, John is referring to the school district's response of adjusting the ATs' schedules to reduce the number of work hours.

A similar comment was made by a different participant, who stated:

Ron added:

Marissa commented on how communication with parents and coaches allowed her to gain the respect of others and feel committed to her role. She explained:

The participants in this study commented on how respect was gained by displaying competence and putting forth an earnest effort in one's position. As an example, Tom explained how the respect to be gained from administrators starts with being competent and proving yourself:

Peter commented on how effective interpersonal relationships helped him gain the respect of others and stay committed to his role at the high school:

Donald also discussed building healthy relationships with others that are based on respect. He explained how earning respect starts with giving respect and appreciation. He stated that “you've got to be able to manage that work in a way that's not burning you out to begin with and a lot of that has to do with a good environment, healthy environment, good relationships that work, you know [show] respect … [and appreciation] and then you can somehow manage your day.”

The last emergent theme, rejuvenation, relates to the necessity of emotionally recharging in order to stay in one's role as an AT. Rejuvenation, as explained by the participants, was achieved by having time to interact with one's peers as well as time away from the role to address personal needs.

Peer interaction and support was identified as one way in which the ATs in this study rejuvenated their commitment. For some, peer interaction helped them understand that others have had similar experiences and that their roles were similar. Ron explained how peer interactions were helpful when he stated that “… it's nice when you go to conventions … and talk to peers and other people that are in the same roles and share stories, good, bad, or indifferent.” In other instances, peer interactions allowed participants to learn specific ways to solve clinical problems, ultimately assisting them in their roles. Jacob commented on how peer interactions helped as much as continuing education: “… there's plenty of opportunity to interact with other ATs or physical therapists or physicians. That really probably helps me often as much as going to a lot of the [continuing education] meetings.” Alluding to continuing education and interacting with other professionals, Mary noted that “[continuing education] helps keep me going in the field by updating me on new procedures, new equipment available, and getting expert advice from fellow professionals is always helpful …”

Another way ATs rejuvenate is by taking adequate time away from their roles to take care of themselves. As Theresa stated, “If you can't take care of yourself you can't take care of other people … you have to leave the [athletic] training room and have time off.” Another participant explained how scheduling time for himself has gotten easier over time:

The above quote exemplifies a relationship among respect, rewards, and rejuvenation in that once the administration understood and respected the ATs' roles, they responded by providing a reward related to scheduling. The flexible schedule has allowed this participant to take care of himself from a physical and emotional standpoint. Further, when the findings of this study are viewed holistically, the results reveal a potential relationship among the emergent themes. Perceived intrinsic rewards, as described by the participants as feeling valued by patients, parents, and coaches, are likely to occur if the AT is respected by others. Respect from others is likely determined by the extent to which they perceive an AT is competent and places a level of concern on providing quality care to the patient and attends to these responsibilities. The ability to commit oneself to professional responsibility is influenced by being able to rejuvenate and take care of personal and professional needs. The Figure displays a phenomenologic model that portrays the emergent themes and their relationships.

The purposes of this study were to explore how ATs working in the high school setting perceived the phenomenon of professional commitment and to understand how these individuals maintained their commitment in spite of working in professionally challenging environments. My results suggest that professional commitment was perceived as having a sense of responsibility to patients. Rewards, respect, and rejuvenation were determinants of commitment in that professional commitment was influenced by receiving intrinsic and extrinsic rewards, giving and receiving respect, and feeling invigorated in one's role because of peer interactions and time away from athletic training.

The sense of responsibility for patients found in the current study corroborates with the findings of Malasarn et al,3 who noted that successful ATs had a genuine concern for their patients' health and well-being. This finding also relates to Winterstein's8 conclusion that ATs in the collegiate setting identified both student-athletes and athletic training students as the focus of their commitment. Winterstein8 stated that the injured athlete represents our primary constituent and customer as a professional. Moreover, the perception of responsibility to the patient corresponds with the foundational behavior “primacy of the patient” from the most recent NATA educational competencies.16 

The current findings identified interactions with athletic training peers as positively influencing the maintenance of professional commitment. This result corroborates the investigation of Poczwardowski et al,11 who demonstrated that health educators engaged in invigorating interpersonal relationships were able to sustain their enthusiasm and maintain commitment to their professional roles. Similarly, social support, such as networking with colleagues, was an influential factor that mitigated role strain among dual-position ATs and physical educators working in the high school setting.1 Perhaps peer interactions help to develop a sense of camaraderie with those in similar positions and allow ATs to look beyond the negative aspects often attributed to demanding health care roles.

In a study17 examining the socialization of ATs in the high school setting, networking with colleagues was seen as a key aspect of learning to deal with one's professional role. Conceivably, interpersonal relationships and interactions that focus on learning to deal with the professional and organizational aspects of one's role allow for the development of confidence and competence; subsequently, a level of respect is gained among one's peers in the organization. Indeed, ATs in the current study identified feeling respected as a prominent aspect of maintaining professional commitment in the high school organization. This finding corroborates with that of Malasarn et al,3 who noted that mutual respect between athletes and ATs was associated with developing commitment and expertise in the collegiate setting.

The dimensions of commitment explained by the participants in this study are consistent with affective and normative commitment. Affective commitment is associated with being in a professional role because one wants or chooses to do so. The essence of affective commitment is that an individual is committed to a professional role because involvement in the professional role produces a satisfying experience.18 In the current study, the satisfying experience was feeling valued and respected by patients, parents, and coaches. Normative commitment relates to feeling obligated in one's role,19 such as the sense of responsibility and duty to their patients and the profession ATs in this study felt. Similar to affective commitment, normative commitment develops when one has positive or satisfying experiences while conducting his or her professional role.

What I did not find in the current study was evidence related to continuance commitment. With continuance commitment, participants in a professional role continue their roles because of the consequences that leaving would bring.18 Examples of negative consequences include failing to earn an income (“I have to work to get paid”) or not gaining enough experience to obtain a more desirable position (“I keep working here because if I don't, I will not have enough years of experience to get the job I really want”).

The affective and normative dimensions of commitment in the current study are consistent with the findings of Winterstein,8 who established that collegiate ATs scored higher on affective and normative commitment and lower on continuance commitment. The affective and normative dimensions of commitment have a great deal of value for both an organization and profession. Affective commitment is associated with employee retention, satisfaction, and willingness to contribute to the well-being of the organization,20 whereas normative commitment is associated with positive job performance, attendance, and good behavior.20 

For the ATs investigated in this study, responsibility to injured athletes was the focus of professional commitment. Maintaining commitment was influenced by receiving intrinsic and extrinsic rewards, giving and gaining respect, and addressing rejuvenation by attending to the various personal and professional needs that arise.

Several implications can be drawn from this study. Leaders in the high school setting can address the continuing education needs of ATs and ensure adequate time to attend professional conferences. Attendance at conferences may facilitate interpersonal interactions with other ATs working in similar settings and perhaps allow for networking that fosters social support. Additionally, continuing education programs can potentially facilitate competence and work to strengthen both an AT's own confidence and the respect of others in the organization.

The findings of this study made clear that rejuvenation was a facet of maintaining commitment. Organizational leaders can examine the work structure as well to ensure that time is available for the AT to address personal and professional needs and subsequently facilitate rejuvenation.

The study was initiated as an open exploration of professional role commitment and, thus, there was not an explicit focus on organizational climate or organizational culture. Each of these aspects can influence one's professional role within an organization. Also, more men volunteered to participate in the study than women. A previous commitment researcher8 identified some gender differences concerning various dimensions; therefore, future investigators should target the experiences of female ATs' commitment and examine their experiences in various work settings. Lastly, the majority of participants were from District 4. Future authors seeking information on professional role commitment should seek to gain perspectives from those in a greater variety of districts. In addition, some participants in this study were dual-position teachers and ATs. Many full-time public school teachers have published reward structures, so this may have influenced their commitment. More research related to this issue is warranted.

This study was made possible by a Great Lakes Athletic Trainers' Association Research Assistance grant. Special thanks go to the athletic trainers who shared their experiences with me.