Newly Credentialed Athletic Trainers’ Onboarding Process During the Transition to Practice

We employed a grounded theory qualitative approach using the theoretical framework of symbolic interactionism. Symbolic interactionism emphasizes how the interaction, culture, and environment affect an individual and how the individual constructs the meaning of their experience.¹⁴  Grounded theory is appropriate when participants have experienced a process, and its use can lead to the development of a theory to explain the process, in this case, onboarding.¹⁵  Institutional review board approval was obtained before initiating the study.

Participants included both employers and employees; however, participants were not matched. Inclusion and exclusion criteria are outlined in Table 1. Purposive sampling was used to recruit participants due to the longitudinal nature of the research. Employee participants included 17 NC-ATs who graduated from professional masters’ programs and were in their first 3 months of employment (11 female, 6 male; 25.6 ± 2.2 years; work settings included college/university, secondary school, and hospital/clinic). Twelve employers participated in this study (6 female, 6 male; years in a role supervising NC-ATs: 8.5 ± 4.9; settings included college/university, secondary school, and hospital/clinic). Participant demographic information is presented in Tables 2 and 3. Data saturation guided the number of participants.

An email was sent through the Board of Certification (BOC) database for employee participant recruitment. We chose the BOC because their system can send emails based on when an individual was certified and the type of professional program (undergraduate versus graduate) they attended. Emails were sent to individuals who graduated from a professional master’s program. The email blast was distributed to 283 individuals. Those who fit the inclusion criteria and were interested in participating emailed the principal investigator (PI) who then contacted the participant to set up a time to describe the study, answer questions, obtain consent, gather demographic information, confirm inclusion criteria, and schedule an interview.

Employee participants were interviewed via phone using a semistructured interview guide 4 times at approximately 3, 6, 9, and 13–15 months after their hire into professional practice. Initial interviews lasted approximately 45–60 minutes, while subsequent interviews lasted approximately 30–45 minutes. All interviews were recorded and transcribed verbatim. Fifteen participants completed all 4 interviews. While 2 were lost to attrition, their initial data were included. Four participants changed employment throughout the study.

Employers of NC-ATs (employer participants) were recruited through various mechanisms. The PI emailed all employers who provided contact information on their vacancy announcements on the National Athletic Trainers’ Association Career Center Website. Snowball sampling was also used to recruit employers. The PI also recruited interested employers at conferences who were subsequently emailed with the same recruitment email initially sent to individuals on the Career Center Website. Employers participated in 1 phone interview that lasted approximately 60 minutes. Data were collected via a semistructured interview guide. Interviews were audio recorded and transcribed verbatim.

Six semistructured interview guides were developed: 4 for employees (1 per interview time point; 3, 6, 9, and 15 months, respectively), 1 for employees who changed employment, and 1 for employers. Each interview guide consisted of approximately 14–20 questions developed based on the specific aims, research questions, and onboarding and transition to practice literature.^1,4,5,7,8,10  Content validity of the instruments was established via peer review using 4 experts in athletic training research and qualitative research that were independent of the research team. Each reviewed the instruments for clarity, content, and validity and provided feedback for improvement. Minor modifications were made to ensure the interview guides addressed the aims and research questions. The instruments were piloted for clarity and flow of the questions on 6 individuals (3 employees and 3 employers) who met the inclusion criteria but were not part of the study. Pilot testing ensured question clarity and flow and established approximately how long it took to complete the interviews. Minor modifications were made for clarity, comprehension, and content. Questions on the follow-up interview guides were modified based on initial findings from the subsequent rounds of interviews with employees. Pilot data were not used in the final analysis.

Data were analyzed via the grounded theory approach described by Corbin and Strauss, which involves constant comparative analysis.¹⁶  The constant comparative process involves returning to the field to collect and compare the new data to emerging categories.¹⁵  Collecting data across the first year of employment facilitated follow-up questions to understand the onboarding process better. The data analysis process used open, axial, and selective coding to construct a description of the emergent codes.^14–16  After each interview, the transcripts were read fully by the research team before coding to gain a sense of the data. On the second reading, keywords and pieces of information were reduced into codes (open coding). The most salient codes were synthesized and organized into categories (axial coding), and connections were made between categories and subcategories (selective coding). The research team independently analyzed the data and then met and discussed the emergent themes until a consensus was reached. Data analysis occurred continuously throughout the data collection process to ensure the constant comparative analysis required by grounded theory.

Multiple methods were used to establish credibility, including (1) multiple analyst triangulation, (2) peer review, and (3) narrative accuracy member checks.¹⁷  Multiple analyst triangulation occurred via the constant comparative data analysis process. The research team analyzed the data and discussed the findings until a consensus was reached. Peer review was also used to provide credibility. After data analysis, 3 peer reviewers reviewed the findings to ensure coherence between the data and emergent themes. The peer reviewers also ensured all meaningful units of data were coded. The peer reviewers did not recommend any changes. Lastly, participants conducted narrative accuracy member checks in which they reviewed their transcripts to ensure accuracy; no changes were needed after this process.

Two emerging themes described the onboarding process for NC-ATs: initial orientation and continued onboarding. These themes are described below, along with subthemes. Additional quotes can be found in Tables 4 and 5. If both groups of participants discussed the themes, they are referred to as participants. If only 1 group discussed that aspect, they are described as employee or employer participants.

An initial orientation was typically provided to introduce new hires to the organization’s values and mission, policies and procedures, and role expectations. The format varied between organizations but often included online modules, in-person meetings, and skill development. Participants reported that initial orientation usually consisted of a broad organizational orientation, a departmental orientation for sports medicine, and a site-specific orientation at the individual AT’s site.

Organizational orientation was the initial phase of orientation for participants, which was broad and commonly involved all new hires of the organization (eg, nurses, physicians, teachers, and professors). Often conducted by human resources, this orientation allowed new hires to learn about the entire organization and procedural information, such as navigating new software systems, receiving a name badge, learning about benefits, and reviewing hospital or overarching organizational policies. This portion of orientation ranged from half a day to 3 days. Kevin, an employer, outlined the organizational orientation:

Overall, participants felt the organizational orientation provided new hires with information about various policies and an opportunity to meet other new hires. However, when orientation was focused more on hospital protocols, some employee participants felt this time could have been better spent learning aspects of their specific site or role. Lily, an employee, commented,

While organizational orientation was beneficial to learning values and policies, it was not always relevant to the ATs’ daily practice. Organizational orientation was most beneficial when it was followed by departmental and site-specific orientations and not used as the only orientation tactic.

In addition to the organizational orientation, some participants described departmental-level orientations in sports medicine departments (eg, college/university sports medicine teams, clinics with outreach ATs in which the department included all athletic training employees). Departmental orientations provided specific information about the role and provided the opportunity to meet other ATs. Not all employees received department-level orientations, especially if hired directly through a secondary school. Participants felt departmental orientations were valuable for learning more about their job expectations and asking questions. Amber, an employee, commented, “I had a specific sports medicine orientation with my Director of Sports Medicine and my head [AT] where she went over expectations, dress code, more specific things to athletic training.” Liam, an employer, provided further details about his departmental orientation, which includes orienting new employees to the area and various procedural tasks:

The departmental orientation also provided opportunities to ask follow-up questions based on the organizational orientation, provided one-on-one instruction on protocols, and competency demonstration. Beth, an employee, shared that she also practiced skills within her departmental orientation. She reported:

Employee participants who had skills practice felt it was a good opportunity to review and receive feedback, while others who did not have skills reviews wished that was a part of their orientation.

The site-specific orientation, which included facility tours and a review of policies and procedures, was potentially the most beneficial orientation aspect for participants and employee participants. Site orientations also facilitated meeting stakeholders at the site where the NC-AT would provide care. Site-specific orientations allowed participants to understand their day-to-day job expectations better. Veronica, an employer, discussed how orientation is provided to ensure the NC-ATs are ready to assume their role:

Part of the site-specific orientation includes helping NC-ATs understand the hierarchy and personalities of stakeholders to help develop relationships. Fiona, an employer, stated:

Despite its usefulness, the site-specific orientation was not as common and tended to be more informal than organizational and departmental orientations. Typically, this included introductions, tours, and shadowing. Haley, an employee, commented:

Once employees had site-specific orientations, they usually assumed their roles as ATs.

Continued onboarding includes the socialization tactics that continued after the initial orientation. Onboarding ranged from no onboarding for some participants to through the first year of employment for others. Formalized onboarding programs described by many employer participants lasted 6 months to 1 year. The formalized onboarding tactics used include the following subthemes: (1) mentoring, (2) site visits, (3) feedback and evaluation, (4) regular meetings, and (5) individual professional development.

Formal and informal mentoring was a critical aspect of the onboarding process, and participants reported support and mentoring were vital as they were socialized into their roles. Some organizations assigned formal mentors to their NC-ATs, who were supervisors or veteran ATs within the organization. Informal mentors included supervisors, peer ATs, and former mentors (eg, preceptors, faculty). Sarah, an employee, described a mentorship program used by her organization, which assigned NC-ATs to seasoned ATs. Through the program, mentoring pairs were assigned various tasks to complete throughout the first 6 months to 1 year of employment. Sarah stated:

Veronica, an employer, described a similar program, which reportedly has improved retention and role understanding in her company. She stated:

Some supervisors had formal mentoring check-ins with NC-ATs. Employees also discussed informal mentoring with their supervisors or other ATs at their facilities, which helped participants understand their roles and improved their practice. Barb commented, “My director is pretty good about checking in every day, seeing how I am doing, seeing if I have questions. He’s good with the day-by-day stuff.”

One consideration when developing a mentoring relationship is to provide NC-ATs with a mentor who is not their direct supervisor. Employee participants felt apprehensive about asking questions directly to the person evaluating them because they did not want to look incompetent. Mandy, an employer, recognized this and assigned another veteran AT to be a mentor. She commented:

Site visits ensured the NC-AT adjusted to their specific setting, specifically in the secondary school setting. During visits, the supervisor, or a seasoned AT, would work alongside the NC-AT, answer questions, and provide feedback. Kevin, an employer, has a group of ATs where a large part of their role is visiting other ATs. He stated:

Often, the supervisor would work alongside them, check in, review the organization of the athletic training facility, and audit medical records. Some employer participants described a form used at site visits to ensure compliance with organizational requirements. Veronica, an employer, stated:

Employees and employers noted benefits of site visits in helping NC-ATs feel supported, get questions answered, and receive feedback and advice. Kevin, an employer, commented:

Beth, an employee, commented, “My supervisor does school visits, so he tries to come twice a month and just come in and make sure everything is going well. So I do feel very supported in that aspect.”

Employee participants desired feedback to ensure they were meeting expectations in their roles. Informal feedback was often provided to participants who worked alongside other ATs, such as in the college setting. Jay commented about informal feedback:

Employee participants were often formally evaluated in their roles at various times throughout their first year, such as 90 days, 6 months, and 12 months. The results and discussion will focus on the formalized feedback process for the NC-ATs; however, it is important to note that not all employees were evaluated or provided feedback.

Formal evaluation included a review of professional behaviors (eg, timeliness, attendance, honesty, integrity), surveys of coaches and administrators, an audit of patient documentation, a review of effective communication, and an evaluation of the quality of care provided. Debbie, an employer, stated:

Barb, an employee, noted similar aspects of the evaluation but also discussed a self-evaluation, which was a part of the evaluation process:

The formal evaluation process allows employees to learn what is going well and what needs improvement.

Liam, an employer, uses the elevation process to form goals the new AT can work on for the next evaluation. He commented, “If there are certain specific needs, those are addressed, and then they’re reevaluated a month after the initial evaluation.”

Another part of the onboarding process was regular athletic training department meetings. Participants employed within the college setting or through a hospital/clinic with multiple ATs had regular meetings. In contrast, participants employed directly through the secondary schools did not have regular meetings with other ATs or health care providers. Employee participants felt these meetings were beneficial for collaborating with other ATs, discussing complex patient cases, and feeling a sense of belonging within the athletic training department. Typically, these meetings occur monthly or every other week. Some employers required the meetings, while they were an option for others. Regular meetings also gave new ATs convenient opportunities to ask questions. Jay commented:

Frank, an employer, highlighted the collaboration that occurred at their meetings. He stated:

Newly credentialed ATs appreciate opportunities to collaborate with other ATs and learn about how they would handle certain situations. For example, Lily’s department meets regularly to discuss relevant topics, such as managing environmental emergencies within their state practice act or difficult situations. She commented:

Employee participants described how their employer supported continuing education and individual professional development for new ATs throughout onboarding. This was important to employees since it helped fund opportunities to get continuing education units and allowed them to gain new skills. Employer support in their professional development made the employees feel valued. Employers often supported this through offering in-services, paying for a subscription to online continuing education (eg, MedBridge), or paying for conference attendance. Lily, an employee through a hospital, noted she was able to collaborate with physicians, which also helped her professional development:

Phil, an employee, discussed employer-led in-services for professional development: “They cover lots of different topics. There was one we all got recertified in CPR and Glucagon and an EpiPen. That was nice.” Employer participants discussed the importance of their role in the employee’s professional development. Supervisors discussed working one-on-one to develop individual goals for their employees. Fiona, an employer, commented:

Employee participants valued continuing education support and professional development from their employer.

In this study, we aimed to examine the onboarding process provided to NC-ATs. The orientation and onboarding processes varied based on the setting. Many who were employed and supervised by ATs or other health care providers (eg, physicians and physical therapists) experienced a formal onboarding process. Participants employed through secondary schools experienced more informal orientations. These results were evaluated within the context of established constructs of organizational socialization, including the socialization model of Pitney et al (ie, 5 phase developmental sequence of envisioning the role, formal preparation, organizational entry, role evolution, and gaining stability) and the theory of organizational socialization of Van Maanen and Schein, which are tactics commonly used to orient a newcomer into the organization.^18,19  In this socialization model, tactical dimensions refer to the way the novice experiences the socialization process through transitional activities structured by the organization. The tactical dimensions are bipolar, in which each tactic has an opposite pole. The tactics are (1) collective versus individual, (2) formal versus informal, (3) sequential versus random steps, (4) fixed versus variable, (5) serial versus disjunctive, and (6) investiture versus divestiture. Organizations can choose socialization tactics to produce desired results in their employees. Collective refers to a group of individuals who are going through the induction process together, in which all members go through the activities and have the same experiences, while in individual socialization, the novice goes through induction tactics and has unique experiences in isolation from others that can be tailored to individual needs. Formal refers to tactics that are clear and are specifically arranged for the novice to learn the roles. In formal orientations, prescribed activities help the novice learn the proper attitude and values of the organization. Informal socialization is less hands-on and is often considered on-the-job training. Sequential includes specific steps that one must take leading to their desired role, and each subsequent step builds upon the prior stage, becoming more complex as the novice learns. Random is characterized by unknown or constantly changing steps to the target, in which one could reach the target without going through specific steps. Novices are exposed to more viewpoints in random socialization than sequential. Fixed and variable socialization refers to the timetable that is associated with socialization tactics. During fixed socialization, the novice will learn how long certain career paths will take to complete. With variable socialization, the timetable is more flexible and not specified when the novice enters the organization and varies depending on the person or situation. The next tactic, serial versus disjunctive, refers to the pattern a novice may take to assume the role of the veteran. In serial socialization, the novice is groomed by a veteran who serves as a role model or mentor for the novice. Disjunctive socialization occurs when the novice does not follow in the footsteps of the veteran, or they do not have information of how to continue in their role. Disjunctive socialization can be stressful for novices, as they do not have anyone to emulate in their role, or they cannot envision how their future will evolve. The final tactical dimension is investiture versus divestiture, which refers to the novice’s identity confirmation when entering the role. Investiture processes confirm the novice’s identity and the skills the novice brings to the organization. Divestiture socialization often disaffirms the novice and tends to remove any vestige of personal characteristics and skills. The novice’s self-perceptions are often rebuilt based on the organization’s beliefs and values, and the divestiture socialization creates strong bonds between the novice and veterans. Our results align with the tactics described in the socialization model.

Initial orientation is an integral part of the transition to practice. It provides new employees with institutional information such as vision, mission, values, policies and procedures, tours, introductions, and specific role expectations.⁸  Previous researchers in athletic training have shown that, in some cases, no orientation is provided; in others, the orientation process can range from formal to informal.^8,20  New ATs most commonly learn on the job as things come up; however, those who had formalized orientation processes rated the orientation process as extremely helpful for managing their roles.^20,21 

The organizational orientation allows the new employee to learn about the organizational values, obtain information about human resources and benefits, and meet other new employees. Often, this aligns with the collective and formal tactical dimensions described by Van Maanen and Schein.¹⁹  Employers and employees value learning more about the organization, which is consistent with employers in other health care fields.^22–24  However, orientation should not stop after merely learning about the organization. Newly credentialed ATs desire orientations specific to their roles as an AT.⁸  Our results showed employees felt the organizational orientation was not as useful for their daily roles; however, employees who had organizational orientation followed by departmental- and site-specific orientations valued the organizational orientation to learn more about the organization and meet other new employees.

The departmental orientation is an ideal follow-up to the organizational orientation, as it provides the opportunity to meet other ATs and provide specific information about the ATs’ role and employer expectations. Departmental orientation occurred most often in the college/university setting or clinic outreach. This orientation should include learning about departmental values, vision, mission, and the departmental context within the entire organization.²²  We recommend the departmental orientation to include skill development, which participants noted was very useful. Orientation models that include skill development (ie, competency-based models) have been widely used with nurses and physician assistants.^22,24  Athletic training departments can include skill development and feedback within orientation to ensure the NC-AT is confident in the skills necessary to perform their roles. This could consist of, among other skills, high-stakes emergency skills such as spine boarding, splinting, oxygen administration, or managing heat illnesses. This type of orientation allows the AT to demonstrate skills while obtaining feedback and ensuring they follow organizational policies. Newly credentialed ATs find practicing skills such as the emergency action plan in a low-stakes scenario extremely beneficial during the transition to practice and value skill development and feedback as a part of initial orientation.⁸ 

Site-specific orientations are vital to ensure NC-ATs understand the expectations and procedures in their respective work setting. We found that most site-specific orientations were informally conducted with a supervisor. This aligns with the individual, informal, and random tactics of the model of Van Maanen and Schein.¹⁹  Researchers have previously demonstrated that, when NC-ATs learn about their roles during orientation, they engage in less trial and error in their positions.⁸  Providing an overview of daily tasks and introducing the NC-AT to stakeholders (eg, other health care providers, athletic directors, and coaches) allows NC-ATs to know what to expect in their roles and increases their confidence. Site-specific orientations can be supplemented with shadowing or treating patients with another clinician and providing feedback to the NC-AT. Gradual exposure to patient care with another AT increases comfort levels during the transition.

Developing an effective orientation requires time, planning, and resources; however, the benefits of orientation and onboarding far exceed employee turnover costs.²³  Supervisors can collaborate with human resources regarding organizational orientation. For department- and site-specific orientation, employers could use the New Athletic Trainer Employee Orientation Checklist as a guide to develop this process.²⁵  Employers can modify as needed to include all aspects of the role. A formal process and checklist can ensure NC-ATs learn all the pertinent information to succeed.

Mentoring relationships are critical in the transition to practice for NC-ATs.^4,20,26–28  Mentors facilitate the transition to practice by providing honest feedback and reassurance, promoting learning, and supporting the new AT.²⁶  Previous researchers have found many mentoring relationships evolve organically and are informal; however, some participants in this study described formal mentoring relationships in which they were assigned to a mentor through their employer.²⁷  Mentoring aligns with the individual and serial tactics of the Van Maanen and Schein socialization model.¹⁹  The described programs lasted 6 to 12 months and could continue if the mentor and mentee were interested. Formal mentoring can be especially useful for individuals in the secondary school setting, as they may not be working directly with other health care providers. Formal mentoring in nursing has resulted in the retention of new nurses, increased competence and professionalism, and a positive working environment, which all positively affect patient care outcomes.²⁹  We found those with an assigned mentor with specific tasks to complete felt they could learn more about their role, gain advice, and have a particular point person to whom they could ask questions. Mentoring can assist NC-ATs in integrating into their setting and feeling connected while gaining confidence in their roles.²⁰ 

If one is not in place already, employers should develop a mentoring program to assist NC-ATs with the transition to practice. Mentors should be carefully selected and trained to ensure success, and employers should consider using experienced ATs interested in serving as mentors.²⁹  Other considerations are the setting and location of practice. For example, employer participants looked at the type of institution (eg, public versus private, small versus large, same school district) and the locations of the mentoring pairs. Mentor training can include topics relevant to transitioning to practice, such as conflict management, stress management, and skill development, as well as common challenges faced during the transition (eg, communication, decision-making).⁶  As a part of the mentoring program, employers could use a guide or checklist to facilitate meetings. The mentor and mentee can meet initially to discuss goals, and then future meetings can promote those goals while also providing the NC-AT with a safe space to ask questions. New clinicians have reported hesitancy in asking questions because they did not want to appear incompetent or inexperienced.⁵  Therefore, it is beneficial to have specific meeting times in which the mentor can check in and ensure the NC-AT is adjusting to their role. Employer participants noted the effectiveness of their mentoring program regarding retention and role integration, which has been demonstrated in athletic training previously.²⁷  As the NC-AT adjusts to their role, the mentoring relationship evolves, and the frequency and formality of meetings can decrease over time.

Athletic training at the secondary school is unique because new clinicians often practice independently without other health care providers physically present.³⁰  The lack of like-minded colleagues present to model best practices can result in role ambiguity, a commonly identified challenge during the transition to practice.⁶  Site visits can be used to ensure NC-ATs understand policies and procedures at their workplace. Newly credentialed ATs desire feedback on their performance, as it helps develop confidence and role validation.²⁸  Suppose site visits do not occur in the secondary school setting specifically; the NC-AT might not receive health care–specific feedback and instead rely on coaches’ and administrators’ opinions on their work performance, which may not be specific to patient outcomes. Site visits help NC-ATs feel supported in their roles. They are an excellent opportunity for supervisors or seasoned NC-ATs to advise new hires, such as ways to organize the athletic training facility, prioritize treatments, or what supplies and equipment to order. Site visits can also be used to set goals and then assess progress on goals.

During the transition to practice, site visits should occur more often in the beginning as the NC-AT adjusts to their setting. Our participants reported varying frequency of site visits, including weekly, bimonthly, and monthly. A colleague often attended the first game to assist with field setup and communication with visiting teams and emergency medical responders while observing the NC-AT providing care. As the NC-AT adjusts and feels more comfortable, site visits can occur less often. Some employers used a checklist during site visits to provide specific feedback and tangible modifications (eg, post athletic training room hours). Employers should conduct site visits regardless of setting to ensure NC-ATs adjust to their roles.

Despite being credentialed and often licensed ATs, the transition to practice is stressful for new clinicians, and receiving feedback can alleviate some stress, increase confidence, and assist with decision-making during the transition.^6,21  New ATs want to improve their skills, and honest feedback is essential for skill development and role validation.²⁶  Many of the previous socialization and transition to practice researchers in athletic training have discussed the importance of feedback; however, it has been described chiefly as informal feedback from the supervisor.^1,6,8,26  Inherent challenges exist for specific feedback in secondary school settings where the AT is the sole health care provider, but input from coaches, administrators, patients, and parents can also help with role validation. Forming relationships with supervising physicians can provide opportunities for feedback on clinical skills.³⁰  If NC-ATs are not getting sufficient feedback, they should seek feedback from supervisors, supervising physicians, patients, coaches, and other stakeholders.

In addition to immediate feedback, evaluations were also used as a part of the continued onboarding process. Evaluations were conducted on a scheduled basis, typically 3 or 6 months after initial hire. Formal evaluations often included self-evaluation and an evaluation by the supervisor. Some supervisors also surveyed coaches and athletic directors to gain a more holistic view of the NC-AT’s skills. Performance evaluation is a valuable tool for employers to provide formal feedback, develop goals, and determine if the NC-AT meets expectations. Supervisors should use this time to establish performance goals and provide resources (eg, continuing education, mentoring) to meet those goals. Organizations should follow best-practice recommendations and regularly conduct evaluations with the NC-AT. Secondary school ATs could be evaluated using the Secondary School Athletic Trainer Evaluation Tool, developed specifically for performance evaluations of secondary school ATs.³¹ 

Newly credentialed ATs, especially those working in the secondary school setting but employed through a hospital or clinic, valued regular meetings with other ATs during their transition to practice. Many new clinicians feel isolated in their roles, and researchers have recommended a greater emphasis on relationship building during onboarding.^28,32  Participants, both employee and employer, noted the importance of regular meetings to build relationships and feel a sense of belonging.

In addition to building relationships, regular meetings can help with collaboration. During their transition to practice, NC-ATs often hesitate to ask for help because they do not want to look incompetent.²⁸  Physicians in new hospitals face similar struggles and do not want to ask for help because they feel uncomfortable asking others or do not want to appear inept.³²  However, physicians also note a culture of collaboration or a chance to develop relationships with coworkers can facilitate asking for help. Our participants reported similar experiences, with those who had regular meetings discussing patient cases feeling more comfortable asking for help. They noted experienced ATs also discussed challenging cases, which made them feel more comfortable asking questions while also learning from the experiences of others. Employers should facilitate regular meetings in which NC-ATs can develop relationships with colleagues, provide an opportunity to ask questions, collaborate, and help new ATs integrate into their organization.

Although NC-ATs are deemed competent to provide patient care once they pass the BOC exam, they still need professional development to enhance their skills and confidence. Continuing education through seminars, journal clubs, monthly in-service, and case study presentations have been used through the onboarding process for ATs.¹³  For new nurses during transition to practice programs, multiple modalities are used for professional development, including formal classes, workshops, in-services, reflective journaling, simulations, and case studies.¹²  Similarly, in-services and workshops were common ways for NC-ATs to develop skills. Employers should also provide funds to attend conferences, which also helps socialize NC-ATs into the profession.

In addition to providing opportunities for professional development, supervisors and mentors can meet with the NC-ATs to set goals and find the resources needed to meet those goals. Past researchers have highlighted that professional development opportunities can be targeted in pursuit of goal achievement.¹  Newly credentialed ATs desire the assistance of mentors or supervisors in finding professional development opportunities that build their skills.²⁸  Supervisors and mentors should meet with the NC-AT to discuss areas for professional development that align with professional goals.

While the 3 most common workplace settings for ATs were all represented (college/university, secondary schools, and clinic/hospital), onboarding practices varied greatly between each setting and organization, making it challenging to generalize most recommendations. While saturation was met in this study, we cannot describe all onboarding practices across all setting types used during the transition to practice for NC-ATs. Future researchers should explore the college setting, especially as the profession moves away from the graduate assistant model to socialize NC-ATs into the profession. Further researchers should include emerging settings such as occupational medicine/industrial athletic training or those working with military or tactical athletes.

Additionally, while, in this study, we interviewed employee participants at multiple time points (3, 6, 9, and 15 months), some onboarding lasts up to 18 months. Longitudinal studies in which authors explore the first 24 months of practice would be beneficial to determine continued processes and perceptions of the success of onboarding on role integration and patient care.

Transition to practice is stressful for NC-ATs; however, providing a thorough and specific orientation and continued onboarding can help NC-ATs manage transition stress. Onboarding provided to NC-ATs mirrors the socialization tactics described by Van Maanen and Schein and are varied based on the individual and organization.¹⁹  Newly credentialed ATs desire a formal review of policies, procedures, and expectations specific to their setting but also desire ongoing meetings, feedback, site visits, and discussions related to their job duties. Additionally, regularly scheduled meetings with athletic training colleagues help the NC-AT feel a sense of belonging and provide an avenue to ask questions and seek advice regarding patient care. Supervisors should meet with NC-ATs regularly, perform site visits to provide feedback, and ensure they are adapting to their roles.

This study was funded through a grant from the National Athletic Trainers’ Association Research and Education Foundation.