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Professional Role Complexities and Job Satisfaction of Collegiate Certified Athletic Trainers Kirk Brumels Western Michigan University
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PROFESSIONAL ROLE COMPLEXITIES AND JOB SATISFACTION OF COLLEGIATE CERTIFIED ATHLETIC TRAINERS
by Kirk Brumels
A Dissertation Submitted to the Faculty o f The Graduate College in partial fulfillment of the requirements for the Degree o f Doctor o f Philosophy Department o f Teaching, Learning, and Leadership
Western Michigan University Kalamazoo, Michigan December 2005
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PROFESSIONAL ROLE COMPLEXITIES AND JOB SATISFACTION OF COLLEGIATE CERTIFIED ATHLETIC TRAINERS
Kirk Brumels, Ph.D. Western Michigan University, 2005
This study examined whether professional role complexities existed for certified athletic trainers (ATCs) employed at the collegiate level, and if so, what impact these role complexities had upon job satisfaction and intent to leave a current position or the profession. The amount and sources of role complexities were examined for collegiate ATCs who were employed in clinical, faculty, or joint appointment positions. Potential for professional role complexities exist in any situation where multiple role obligations are present in the workplace. Professional role complexities for health care employees often manifest into tension, dissatisfaction, lack of energy or ambition, and decreased attention or commitment to patient care possibly jeopardizing the patient’s health and well being (Hardy & Conway, 1988). A random sample of 1,000 collegiate ATCs were sent invitations to participate in this study by taking an online survey. 348 responses were received. Descriptive statistics were calculated for the demographic, role orientation, role complexity, job satisfaction, and intent to leave sections of the study. Respondents were grouped into demographic and professional role categories to facilitate ANOVA and multiple regression analyses between the variables of overall role complexity, role conflict, role ambiguity, role incongruity, role incompetence, role overload, inter-sender conflict, intra-sender conflict,
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inter-role conflict, job satisfaction, intent to leave current position, and intent to leave profession. Statistical examination of felt role complexities among the study respondents found that collegiate ATCs with clinical or joint appointments experienced various role issues that affected job satisfaction. Approximately 20% of clinicians and joint appointees experienced moderate to high levels of stress due to global role complexity, while 30% of them felt similar levels of stress due to role conflict. Twenty three percent of clinicians and 36% of joint appointees experienced at least moderate stress from role ambiguity while role overload accounted for moderate to high levels of stress for 36% of clinicians, 37% of faculty, and 41% of joint appointees. Role complexity predicted job satisfaction, intent to leave current position, and intent to leave profession for clinicians, while only predicting intent to leave current position for faculty members and job satisfaction for joint appointees.
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UMI Number: 3197558
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© 2005 Kirk Brumels
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ACKNOWLEDGMENTS This process is not something that I could have done alone. Stephanie, you inspire me. You have been a rock throughout this whole process and I am proud to be your husband. When I wavered, you didn’t. When I had self-doubts, you didn’t. When I was unsure of the reasons why I was doing this, you weren’t. I appreciate your patience, perseverance, and passion through this process, because without it, I am not sure I would be writing this page. To Hunter and Rebecca, I want to tell you that I appreciate your understanding about why I missed activities and events over the past four years because “daddy had to go to school”. I love you guys and I am proud to be your dad. To my family, friends, and colleagues I want to thank you for being supportive of me and I appreciate all of the moments of understanding and interest you have shown. A man is only as good as those around him and I am proud to be your son, son in- law, brother, brother in - law, friend, classmate, and co-worker. I thank you for your impact and interest in my life. You all have been a vital part of this process and my life. Andrea, Louann, and Rich: thank you for reading, correcting, challenging, supporting, encouraging, and celebrating during this process. I thank you for cultivating within me an enthusiasm and excitement for lifelong learning and scholarly work. You are each true examples of how we as educators should conduct ourselves and I can only hope that I can have the same amount of impact on others that you have had on me.
Kirk Brumels
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TABLE OF CONTENTS ACKNOWLEDGEMENTS.......................................................................................
ii
LIST OF TABLES.....................................................................................................
vii
LIST OF FIGURES...................................................................................................
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CHAPTER 1: INTRODUCTION............................................................................
1
Purpose Statement.........................................................................................
2
Background of the Study..............................................................................
3
Athletic Training Profession.............................................................
3
Role Complexities.............................................................................
7
Job Satisfaction..................................................................................
8
Rationale for the Study..................................................................................
8
Research Questions.........................................................................................
15
Method Overview...........................................................................................
16
Definitions of Terms.......................................................................................
16
Summary........................................................................................................
20
CHAPTER 2: REVIEW OF THE LITERATURE..................................................
21
Definition and History of Role Theory.......................................................
22
Facets and Sources of Role Complexities...................................................
23
Role Conflict.....................................................................................
24
Role Ambiguity................................................................................
25
Role Overload....................................................................................
25
Role Incongruity...............................................................................
26
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Table of Contents - Continued Role Competence / Incompetence....................................................
27
Role Qualification.............................................................................
27
Role Complexities in Health Care Professions...........................................
28
Faculty................................................................................................
29
Clinicians............................................................................................
30
Joint Appointees................................................................................
31
Role Orientation................................................................................
35
Job Satisfaction..............................................................................................
35
Role Complexities and Job Satisfaction of Health Care Professionals
37
Summary.........................................................................................................
38
CHAPTER 3: METHODOLOGY.............................................................................
40
Pilot Study and Instrument Calibration........................................................
40
Demographics....................................................................................
42
Role Orientation.................................................................................
42
Role Complexity................................................................................
44
Job Satisfaction...................................................................................
48
Study Sample and Data Collection................................................................
49
Limitations of Study.......................................................................................
50
Summary.........................................................................................................
51
CHAPTER 4: RESULTS................................................................................................
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Demographics.....................................................................................................
54
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Table of Contents - Continued Examination of Role Orientation..........................................................................
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Variable Reliability Testing...............................................................................
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Examination of Role Complexity Typologies..........................
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Sources of Role Complexity....................................................................
75
Role Group Comparison for Role Complexity.......................................
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Demographics and Role Complexity.......................................................
82
Division............................................................................................
83
Age....................................................................................................
85
Career Length...................................................................................
87
Examination of Job Satisfaction and Intent to Leave......................................
93
Relationships Among Role Complexity, Job Satisfaction, and Intent to Leave....................................................................................................
96
Multiple Regression Analysis..........................................................................
97
Summary................................................................. CHAPTER 5: DISCUSSION............................................................................................ Overview of Significant Findings................................................. ...................
109 109
Role Orientation...........................................................................................
110
Role Complexities.......................................................................................
113
Job Satisfaction............................................................................................
118
Intent to Leave.............................................................................................
119
Demographic Effects...................................................................................
120
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Table of Contents - Continued Summary...........................................................................................................
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Implications o f Current Findings......................................................................
126
Recommendations for Further Research..........................................................
131
Conclusion.........................................................................................................
133
REFERENCES................................................................................................................
135
APPENDIX A: Pilot Study Data..................................................................................
143
APPENDIX B : Survey Instrument...............................................................................
147
APPENDIX C: Invitations to Participate in Study......................................................
159
APPENDIX D: HSIRB Approval................................................................................
162
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LIST OF TABLES
1. NATA and Study Population Demographics......................................................
55
2. Study Respondent Demographics........................................................................
56
3. NATA and Study Population Demographics for Primary Professional Positions..............................................................................
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4. Primary Role Responsibility Grouping...............................................................
60
5. Role Orientation for How Time is Actually Spent..............................................
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6. Role Orientation for Ideal Time Expenditure......................................................
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7. Role Orientation Most Appropriate for the Athletic Training Profession
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8. Role Orientation Most Often Promoted by Direct Supervisor............................
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9. Confirmatory Factor Analysis for Role Complexity Typologies.........................
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10. Multivariate Analysis for Role Complexity Question # 2 8 ................................
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11. Multivariate Analysis for Inter-role Typology.....................................................
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12. Level of Role Complexity by Role Grouping......................................................
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13. Stress Levels According to Individual Role Complexity Question....................
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14. Descriptive Statistics for Individual Role Complexity Variables......................
81
15. ANOVA Analysis of Role Groups and Role Complexity Variables................
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16. Descriptive Statistics According to Institutional Division / Level....................
83
17. ANOVA According to Institutional Division / Level.........................................
84
18. Tukey HSD Post Hoc Evaluations for Institution Division / Level..................
85
19. Descriptive Statistics According to Respondent Age........................................
86
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List of Tables - Continued 20. ANOVA According to Respondent Age..............................................................
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21. Descriptive Statistics According to Number of Years Since NATA Certification.............................................................................................
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22. ANOVA for Years Since NATA Certification..................................................
89
23. Descriptive Statistics According to Number of Years at Current Position
91
24. ANOVA for Years at Current Job.......................................................................
92
25. Descriptive Statistics for Job Satisfaction and Intent to Leave.........................
93
26. ANOVA Analysis of Role Groups and Job Satisfaction / Intent to Leave
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27. Tukey HSD Testing for Intent to Leave Current Position by Role Group
95
28. Tukey HSD Testing for Intent to Leave Profession by Role Group..................
95
29. Correlation Table for Study Variables................................................................
96
30. ANOVA Statistics for Clinical Practice Respondents and Dependent Variables...................................................................................
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31. Multiple Regression Analysis for Clinical Respondents..................................
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32. ANOVA Statistics for Faculty Role Respondents and Dependent Variables.........................................................
100
33. Multiple Regression Analysis for Faculty Respondents.................................
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34. ANOVA Statistics for Joint Appointee Respondents and Dependent Variables...................................................................................
102
35. Multiple Regression Analysis for Joint Appointees.........................................
103
36. ANOVA Statistics for Study Population and Dependent Variables................
104
37. Multiple Regression Analysis for Study Population.........................................
105
38. Pearson Correlation Analysis for Time Variables............................................
106
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List of Tables - Continued 39. Stepwise Regression Model for Job Satisfaction, Intent to Leave Position / Profession.............................
xx
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LIST OF FIGURES
1. Theoretical Role Responsibilities and Obligations.........................................
10
2. Potential Disfiguration of Role Obligations Due to Role Complexities
11
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CHAPTER 1: INTRODUCTION
The administration and daily operation of intercollegiate athletic programs is multifaceted and complex with numerous individuals working together in order to achieve success. A high level of interpersonal and departmental interaction is considered necessary amongst the administrators, coaches, athletes, athletic trainers, equipment managers, and support staff who are involved in the daily operation of athletic programs. One professional involved in such an environment is the certified athletic trainer (ATC). Athletic training is a serving profession, and the job expectations for collegiate clinical ATCs are demanding, given obligations to multiple teams, individual participants, and the administrative tasks of providing appropriate medical coverage. The multiple roles of the collegiate ATC often clash as they perform the responsibilities expected for clinical practice, faculty work, and joint appointments. Athletic training education faculty and administrators can experience difficulties in performing these roles due to multiple responsi bilities toward teaching, research, and service. An ATC employed in a joint job appointment situation may have responsibilities to both the athletic and academic department and experience demands from two sources, increasing the potential for conflicts on time and attention. Upon examination of general workplace stress levels, Rizzo (1970) found a decrease in both individual satisfaction and role effectiveness as a result of added stress in the workplace. Professionals involved in athletics possess levels of job stress that are higher than other similar occupations, and also have a significant amount of interpersonal and interdepartmental interaction (Ryska, 2002). Given the fact that
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intercollegiate athletics are extremely competitive and the operation of programs is complex, negative psychosocial responses due to excessive stress may have detrimental effects on the interpersonal relationships and performance effectiveness of those who work in these settings. Ryska reports that some of the more common responses to occupational stressors are anxiety, fatigue, aggression, low social support, illness, poor productivity, and decreasing mental and physical involvement in the work place. Purpose Statement This study examined the extent to which college ATCs experience role complexities. Within this context, role complexities refers to the overall concept of role stress or role strain, as well as, one of the more specific typologies associated with them, including: role conflict, role ambiguity, role overload, role incongruity, role incompetence, and role qualification (Hardy & Conway, 1988). The amount and sources of role complexities were examined for collegiate ATCs who provide health care services to intercollegiate athletics, classroom or clinical instruction within the athletic training education program, or components of both. Determining the sources of any such role complexities could be useful in guiding governance issues such as supervision, management, and financial remuneration. Also, beneficial characteristics and aptitudes needed for individuals who wish to pursue a career in athletic training may be better understood after examination of the role complexities of collegiate ATCs. In addition to role complexities, job satisfaction and intent to leave the job were also examined as part of this study. By examining role complexities and job satisfaction together, an attempt was made to determine the effects that role complexities have on a
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collegiate ATCs propensity to leave the job. The objective of this study is to broaden the allied health profession’s body of knowledge regarding role complexities and job satisfaction to the field of athletic training and particularly to those ATCs who work in colleges or universities. Background of the Study In order to understand the rationale for undertaking this research, it is important to examine the historical and current environment that surrounds the profession of athletic training. Educational programming and accreditation have changed the landscape of athletic training preparation and practice. In addition it is also important to understand the theories behind role complexities and how they affect job satisfaction issues of allied health professionals. The following sections provide background information on the profession of athletic training, role complexity theories, and job satisfaction measurements that ultimately served as the foundation for this project. Athletic Training Profession Certified athletic trainers (ATCs) are American Medical Association (AMA) recognized allied health professionals, credentialed by the Board of Certification (BOC). They are often employed in colleges, high schools, and professional sports. Other occupational arenas where ATCs work include health care clinics, physician offices, and in industry (Hillman, 2000). Although all settings have their own sets of stressors, this research focuses on the stress caused by role complexities of the college ATC. Certified athletic trainers may be employed in one of several roles at an institution of higher education. The percentage of time devoted to each role and job
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responsibility may vary between individuals and institutions. First, an ATC might be employed through the athletic department as a clinical practitioner responsible for providing health care services to the institution’s student / athletes. Athletic trainers in these positions are responsible for many domains of health care and routinely work with physicians, nurses, athletic training students, coaches, strength and conditioning specialists, emergency medical personnel, nutritionists, other allied medical professionals, and support staff in order to deliver appropriate medical coverage (Arnheim & Prentice, 2002). Included in these health care domains are the following six areas of emphasis: (a) injury prevention and risk management, (b) recognition, evaluation, and assessment of injuries, (c) immediate care of injuries or illnesses, (d) treatment, rehabilitation, and reconditioning, (e) health care organization and administration, and (f) professional development and responsibility (Arnheim & Prentice, 2002). Secondly, ATCs may be hired in traditional faculty roles with teaching, scholarship, and service responsibilities. Individuals in these positions are part of the academic departments responsible for providing education to athletic training students in accordance with a pre-determined set of competencies and proficiencies that address the skills needed to become qualified in providing care within the six aforementioned performance domains (Carr & Drummond, 2002). Certain faculty positions may have an instructional teaching load that consists of both clinical and classroom instruction. Others may include responsibilities to the academic programming or administration of the institution’s athletic training education program (ATEP).
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The third university model involves an ATC combining both clinical practice for the athletic department and faculty responsibilities in the athletic training education program (ATEP). These joint appointments between athletics and academics can take many forms in terms of time and responsibilities. Formal assignments to both departments create a unique set of job responsibilities with regard to the academic obligations of teaching, research, and service, as well as, clinical practice, supervision, and teaching. In 1970, when the first certification examination for athletic trainers was administered, four possible routes existed to qualify to take the exam: (a) graduation from a NATA approved undergraduate level athletic training program, (b) completion of an apprentice/internship program in athletic training, (c) graduation from a program in physical therapy, and (d) the special consideration route (given to those who were actively engaged as an athletic trainer for a minimum of 5 years) (Delforge & Behnke, 1999). During the 1980s the physical therapy degree and special consideration route were eliminated, and in 1997, the Board of Certification (BOC) eliminated the apprentice/internship route, creating the current educational standards that must be met by all ATEPs. Required national standards within the undergraduate degree program were initiated in order to take “a step toward standardization of the educational requirements for certified athletic trainers” (Delforge & Behnke, 1999, p. 59). In 1997, the BOC required that by the year 2004, all candidates must possess a degree from an undergraduate level athletic training education program accredited by the Commission for Accreditation of Allied Health Education Programs (Delforge & Behnke, 1999). The degree program includes classroom and clinical instruction. In
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addition, each student must obtain documented qualitative experiences that assess and verify clinical proficiencies and competencies. The didactic educational requirements for students studying athletic training have come a long way from the first recommended curriculum for athletic trainers, approved by the NATA Board of Directors in 1959. These classroom requirements consist o f both general pre-health professional courses and courses that specifically address the educational requirements needed for success as an entry-level athletic trainer. In total, the classroom experiences specifically address the knowledge necessary for an individual to become competent in the six aforementioned performance domains, and to provide appropriate medical coverage and health care responsibilities (Carr & Drummond, 2002). The clinical education requirements involve the teaching and performance of entry-level skill competencies and proficiencies as determined by the NATA Education Council Competencies in Education Committee. The clinical education requirements focus on, and create a structure by which, competencies and proficiencies relating to the practice of athletic training are taught and evaluated. These competencies address the cognitive, psychomotor, and affective domains of the skills and knowledge deemed appropriate for an entry-level athletic trainer. The teaching, practice, and evaluation of these competencies in clinical experiences are completed under the guidance and supervision of an Approved Clinical Instructor (ACI) (NATAEC, 2004). Requirements for becoming an ACI include: certification as an athletic trainer by the BOC, a minimum of 1 year experience as an ATC, and completion of an instructional seminar (NATAEC, 2004).
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Therefore, a current athletic training student wishing to be a candidate for certification by the BOC must graduate from an accredited undergraduate athletic training education program (NATABOC, 2004). After successful completion of this degree program the student becomes eligible to take the certification exam currently comprised o f three sections: (a) written, (b) oral practical, and a (c) written simulation portion. The three test segments objectively evaluate knowledge of the six performance domains of the profession of athletic training (NATABOC, 2004). Role Complexities The term role complexities will be used to describe the overall concept of role stress or role strain, as well as, the more specific typologies associated with them. Hardy and Conway (1988) created a model that divided the concept of role stress into facets based on previous analysis of role theory along with their own research (Hardy & Conway, 1988). They have produced the most common, influential, and frequently researched facets of role complexities found in the literature. These include: role conflict, role ambiguity, role overload, role incongruity, role incompetence, and role qualification. Literature implies that when people have multiple role obligations and responsibilities, the potential for role complexities exists (Acorn, 1990; Goode, 1960; Hardy & Conway, 1988; Kahn, Wolfe, Quinn, & Snoek, 1964; Rizzo, House, & Lirtzman, 1970). Most individuals have multiple roles, due to the simple fact that they are all members of a society, family, community, or occupation (Kopala, 1994). These roles carry with them obligations and responsibilities that may conflict with each other, creating a form of role stress. When the obligations or responsibilities causing stress
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originate from an occupation or professional role, it is known as professional role stress (Kopala, 1994). Professional role complexities within health care education settings can arise due to multiple obligations to students, patients, and employers (Kopala, 1994). When role complexities occur amongst health care professionals they often manifest into tension, dissatisfaction, lack of energy or ambition, and decreased attention and commitment to patient care. One or more of these effects might lead to decreased quality of care and possibly jeopardize the patient’s health and well being (Hardy & Conway, 1988). Job Satisfaction Job satisfaction has been described as feelings that individuals have about their job in its entirety and specific aspects of it (Spector, 1997). Role complexities in the health care professions have been shown to affect job satisfaction (Acorn, 1991; Coverman, 1989; Deckard & Present, 1989; Fain, 1987; Spector, 1985). For example, Acorn (1991) determined that higher levels of role complexity had an adverse affect on job satisfaction. This supported the findings of Fain (1987), who reported that role strain was negatively related to job satisfaction, which in turn supported the previous work of Kahn et al. (1964). Rationale for the Study The impetus for improving educational standards, creating a standard curriculum, and delineating clinical proficiency and competency requirements was based on a desire for athletic trainers to become more competitive in the healthcare delivery system, eliminate educational disparities of entry-level athletic trainers, and
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respond to the additional need for athletic training services in new settings (Starkey, 1997). The intended outcomes of the education reform include: standardizing the certification route for athletic trainers, aligning athletic training education with other health care professions, improving the quality, reputation, and recognition of ATCs, and improving the quality of clinical education for athletic training education program students (Craig, 2003). While this intention is appropriate and sound, this new policy could also have negative implications for current ATCs who are working at the collegiate level. They might be forced to take on additional roles to address students’ educational needs, thus creating another source of professional role complexity. Educational responsibilities placed on ATCs, who do not possess prior educational experience to draw upon, can lead to poor outcomes regarding teaching effectiveness and student learning (Weidner, 2002 ).
Figure 1 is a theoretical depiction of the various influences that affect the lives and professional role complexities of collegiate ATCs. It offers a visual representation of the many responsibilities that “pull” on the time, skills, and abilities of athletic trainers. It lists a few of the responsibilities and obligations that may be present in the personal or professional lives of ATCs and contribute to felt role complexities, but it is in no way completely inclusive. There might be additional variables not depicted in Figure 1 that are specific to individual ATCs and their employment situations. It is reasonable to assume that role complexities will be felt if these varied responsibilities are not kept in check. In conceptualizing these figures it is unfortunate that the depiction is two dimensional and static. Figure 1 assumes that each category has the same amount
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10 of influence on the life of the individual. In reality these pressures are not symmetrical or similar among individuals and the diagram should take on more of an active threedimensional look with each and every obligation or responsibility exerting pressure or pull on the time and roles of the certified athletic trainer. Research
Clinical Practice
Social Obligations
Collegiate Certified Athletic Trainer
Continuing
Family
Education
Teaching
Service / Committees Faculty Responsibilities
Figure 1 Theoretical Role Responsibilities and Obligations Figure 2 more accurately depicts what happens to the overall role responsibilities that a collegiate ATC may have. The amoeboid shape represents the ever changing and continually moving aspect of role complexities. Given this phenomenon, the lines of responsibility often times become blurred and imprecise. The “shape” of the professional role will be different for all athletic trainers, based on the role responsibilities and obligations that they may face. This “shape” may change on a hourly, daily, weekly, or yearly basis depending on the individual situation. It would be
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difficult to find two sets of responsibilities and obligations that are exactly the same among individuals regardless of how similar their employment situations may be. Social Obligations
Clinical Practice
Research
Family
Collegiate Certified , Athletic Trainer
Teaching
Committees
Faculty Responsibilities
Figure 2 Potential Disfiguration of Role Obligations Due to Role Complexities
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12 These figures depict multiple potential sources of stress and role complexity, including personal, social, and professional activities. While it is important to note that many potential sources of role complexity exist, it is also important to understand that this project focuses primarily on the professional role activities that may lead to role complexity. The areas of social and personal role complexity are not examined here, but are important areas of future research. Prior to the 1997 educational reforms, it was commonplace for college athletic departments to use students participating in the internship route toward certification in the provision of medical care and coverage. Elimination of the internship route to certification has forced institutions to either hire additional certified athletic trainers to make up for the loss of the student athletic trainer assistance, pursue the creation of an undergraduate program in athletic training to maintain student assistance, or add additional responsibilities to the jobs of current ATCs (Williams & Hadfield, 2003). Therefore, if an institution chooses to eliminate its use of athletic training students, the collegiate ATC may experience additional stress from having to perform the responsibilities normally assigned to students in addition to their pre-existing duties. On the other hand, if the institution decides to offer an undergraduate athletic training education program in order to maintain the assistance of student athletic trainers in providing medical coverage, the participation in the additional academic responsibilities of creating an undergraduate major in athletic training and the well-ordered involvement in clinical instruction may be a necessary addition to a collegiate ATCs job description (Craig, 2003).
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13 Previously, Foster and Leslie (1992) found that athletic trainers with less than 6 years of experience had difficulty allocating time for clinical teaching. Foster also noted that athletic training professionals who had formal teaching preparation were able to provide a better clinical education experience due to their increased breadth of teaching techniques. The faculty role alone could lead to role complexity, but when this role is added to the clinical role of ATCs, the possibility of role stress increases. Educational roles forced on ATCs, who do not possess previous educational experience, can lead to poor outcomes regarding teaching effectiveness and student learning (Weidner, 2002). When a particular institution decides not to initiate an accredited undergraduate athletic training education program, the loss of students and their ability to assist in providing medical coverage to intercollegiate athletic teams will directly affect the ATCs at that institution. It is a reasonable assumption and possibility that a college / university may choose to utilize entry level ATCs as graduate assistants (GA) replacing either undergraduate students or other full time ATCs. While the employment of GA’s might be a prudent fiscal decision it does not necessarily eliminate the supervisory responsibilities of the institution’s ATCs over such entry-level personnel. Therefore, although this might alleviate workload issues, it still may create additional supervisory responsibilities and demands potentially leading to additional role complexities (Craig, 2003). The elimination of athletic training students at non-accredited institutions and not replacing them with other personnel will likely increase the workload of the ATCs in order to maintain the quality of care expected by the athletic department. This also can lead to role complexities, employee burnout, and increased expenses for the institution in hiring additional ATCs to maintain quality care (Craig, 2003).
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14 Role complexities found among the multiple expectations of patients, students, and the institution have been examined in other allied health care professions (Lambert & Lambert, 2001; Papp & Aron, 2000; Rutter, Herzberg, & Paice, 2002). Escalating expectations for faculty, staff, and students have been observed now that the field of athletic training has undertaken educational reforms creating academic requirements similar to other health care professions (Perrin & Lephart, 1987). The ever-increasing demands on traditional academic faculty, along with the escalating workload assumed by practicing athletic trainers in a collegiate setting, create a unique performance challenge for the collegiate athletic trainer (Perrin & Lephart, 1987). Failure to meet conflicting expectations from numerous sources is exacerbated by the prioritizing of the very same multiple responsibilities and obligations. According to Ruby (1998), the hierarchical delineation of job preference is made apparent by the amount of time faculty attribute to the tasks of teaching, research, and service. Therefore, multiple responsibilities affect job performance making it difficult to meet all the expectations and obligations, putting professional credibility and reputations in jeopardy (Piscopo, 1994). Research on the role complexities of certified athletic trainers working in collegiate settings, and the implications of those complexities upon overall job satisfaction and propensity to leave the job was non-existent. Using research to determine whether collegiate ATCs actually experience role complexities may be useful in assisting administrators with personnel management. This research could also prove beneficial in understanding characteristics and aptitude needed for individuals who wish to pursue a career in athletic training.
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15 Research Questions We know from the review of the literature that role complexities are multifaceted and present in many professions. These complexities may adversely affect job performance and satisfaction of college ATCs. This research focused on the stress caused by role complexities of the college ATC in an attempt to determine if role complexities are present and what impact they have on overall job satisfaction. The population for this study was ATCs who are employed in a collegiate setting with responsibility o f either providing health care services to intercollegiate athletics, classroom or clinical instruction within the athletic training education program, or components of both. The following research questions were examined and formed the basis for the selection, modification, and use of the survey instrument. 1. What types of role complexities are experienced, and to what extent are they felt by college ATCs whose responsibilities include either: (a) clinical practice, (b) faculty / instruction, and/or (c) combination of clinical practice and faculty / instruction? 2. What factors present in the work environment create role complexities for the college ATC? 3. To what extent is job satisfaction felt by college ATCs whose responsibilities include: (a) clinical practice, (b) faculty / instruction, and/or (c) combination of clinical practice and faculty / instruction? 4. What is the relationship among role complexities, overall job satisfaction, and propensity to leave the job for college ATCs whose responsibilities include:
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16 (a) clinical practice, (b) faculty / instruction, and/or (c) combination of clinical practice and faculty / instruction? Method Overview The research design for this study was quantitative in nature and utilized a survey to gather information regarding demographics, role orientation, role complexities, job satisfaction, and intent to leave. A survey was chosen because by definition it is an appropriate instrument for obtaining numeric descriptions of trends, opinions, feelings, beliefs, and attitudes, and allows for some generalization about a population (Creswell, 2003). Portions of the survey were modified from an existing survey instrument used to evaluate components of role complexity for nursing faculty (Mobily, 1987). Specific details regarding this methodology are offered in chapter three. Definition of Terms For the purpose of this study the following definitions and abbreviations of terms apply. Approved Clinical Instructor (ACI) NATABOC certified athletic trainer with at least one year of experience as an athletic trainer, and who has completed a clinical instructor training session. Responsibilities are to provide instruction, demonstration, and evaluation o f clinical proficiencies of athletic training students, in clinical experience settings, via direct supervision (NATAEC, 2004). Athletic Training Education Program (ATEP) Title and acronym used to describe the educational programming of accredited athletic training education programs. Usually refers to both the didactic and clinical aspects of athletic training student educational preparation.
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17 Board o f Certification (BOC) Board responsible for certifying athletic trainers and to identify for the public, quality healthcare professionals, through a system of certification, adjudication, standards of practice and continuing competency programs (NATABOC, 2004). Certified Athletic Trainer (ATC) An allied medical health professional certified by the Board of Certification responsible for the enhancement and quality of health care for athletes and those engaged in physical activity (NATA, 2004). Clinical Education An athletic training student’s formal acquisition, practice, and evaluation of Entry-Level Athletic Training Clinical Proficiencies. These skills are to be formally evaluated under direct supervision of an ACI and may occur in the classroom, laboratory, or clinical education experience settings (NATAEC, 2004). Clinical Instructor (Cl) NATABOC certified athletic trainer or other qualified athletic trainer with at least one year of experience in their area of expertise. Responsibilities include teaching, evaluating, and supervision of athletic training students in their field experiences, but are not held responsible for the final formal evaluation of clinical proficiencies (NATAEC, 2004). Clinical Setting A clinical environment where comprehensive health care services are provided. Athletic training students must complete a minimum of two academic years of clinical experience within such setting (NATAEC, 2004).
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18 Clinical Supervision Supervision of an athletic training student, by either an ACI or CI. Clinical Proficiencies The common set of athletic training skills that entry-level athletic trainers should possess (NATAEC, 2004). Council on Accreditation o f Allied Health Education Professions (CAAHEP) Largest programmatic accrediting agency in the health sciences. Reviews and accredits more than 2000 educational programs in 21 occupational fields, one of which is athletic training (CAAHEP, 2004). Direct Supervision Instruction and evaluation of clinical proficiencies by an ACI, consisting of constant visual and auditory contact during the interaction with the athletic training student (NATAEC, 2004). Educational Competencies The knowledge, skills, and values that must be included as part of entry-level athletic training education programs (NATAEC, 2004). Field Experience An informal learning and practice setting for an athletic training student to apply the Entry-Level Athletic Training Clinical Competencies under the clinical supervision of an ACI or CI. These settings must include athletic training rooms, athletic practices, and athletic events and the supervising certified athletic trainer must be on site (NATAEC, 2004).
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19 Job Satisfaction An attitudinal variable that describes how an individual feels about his / her job and its parts. A high level of job satisfaction indicates that an individual likes the job and vice versa (Spector, 1997). National Athletic Trainer’s Association (NATA) The professional membership organization of athletic trainers, which was founded in 1950, and includes more than 27,000 members (NATA, 2004) National Athletic Trainer’s Association Education Council (NATAEC) Council and committees responsible for all aspects of athletic trainer education, including entry-level, advanced, graduate, and continuing education. Role Complexity The overall concept of role stress, role strain, and other role typologies. Role Strain Internally felt role complexity in meeting and fulfilling one’s role obligations (Goode, 1960). Role Stress Externally felt role complexity often consisting of role ambiguity, role conflict, role incongruity, role overload, and role qualification (Hardy & Conway, 1988). Supervision Contact with athletic training students during their field experiences. Personal and verbal contact between the student and ACI / CI who plans, directs, advises, and evaluates their overall performance (NATAEC, 2004).
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20 Summary Athletic training education and practice are changing due to the recently implemented educational standards. The addition of educational competencies and proficiencies to be taught at the undergraduate level may create new responsibilities for ATCs employed at these institutions. An examination of how these changes are affecting the lives of those responsible for implementing them will be useful in assessing how best to prepare, govern, and supervise such individuals. Understanding the role complexities inherent in particular positions may provide additional information that can also be valuable in the recruitment of professionals into the field.
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21 CHAPTER 2: REVIEW OF THE LITERATURE This chapter examines previous literature and research regarding the two major areas o f emphasis studied in this investigation: role theory and job satisfaction. The first section is dedicated to role theory and consists of an overview of the topic, discussion regarding the facets of role complexities, the sources of role complexities, and the role complexity literature in health care. Emphasis is placed upon examining the literature regarding role complexities for the practicing clinician, the health profession educator, and those with joint appointments who are involved in both teaching and clinical work. Role complexities will be broken down into the two categories of role stress and role strain and their subset typologies. These have been the delineations of role complexity most often studied in the literature. The second section looks at job satisfaction as an overall theory, and then more specifically, how job satisfaction is affected by the amount and sources of role complexities perceived by the health care professional. A literature review was also undertaken regarding composite and facet scales as ways to study job satisfaction. This investigation will specifically evaluate the role complexities and job satisfaction of collegiate athletic trainers. However, since no such previous research has been done in athletic training, the literature review was undertaken using the closely related fields of nursing, physical therapy, and medicine. It was felt that these health professions possessed similar educational and practice situations that would allow comparison to athletic training.
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22 Definition and History of Role Theory Organizations are complex centers of intertwined, patterned, and concerted activity, in which an individual, who is part of the organization, plays a role (Kahn, et al. 1964). Many authors have examined role theories and role complexities (Biddle & Thomas, 1966; Goode, 1960; Hardy & Conway, 1988; Kahn, Wolfe, Quinn, & Snoek, 1964; Rizzo, House, & Lirtzman, 1970). Biddle and Thomas (1966) sum up a role within an organization as being defined by: “social norms, demands, and rules: by the role performances of others in their respective positions; by those who observe and react to the performance; and by the individual’s particular capabilities and personality” (p. 4). This definition of a role has its foundation in the work of Kahn, et al., who believe that people in an organization behave in two distinct “environments: ’’ the objective environment and the psychological environment. The authors believe that “the objective environment of a person consists of real objects and events, verifiable outside his consciousness and experience. The conscious and unconscious representations of the objective environment constitute the psychological environment of the person” (1964, p. 12). The term role complexity is utilized in this study to define the overall concept of difficulty and stress in performing a professional role. A better understanding of the various sub-concepts of role complexity is needed to understand role complexity as a whole. In applying the, “environment” theory (Kahn, et al., 1964), there would be two areas of an individual’s professional role that would contribute to role complexities. First, the physical structure, resources, people, and support of the workplace should be examined as a potential source of role complexity. This has become known as role
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23 stress and Hardy and Conway (1988) have defined it as when the “social structure creates very difficult, conflicting, or impossible demands for occupants of positions within it” (p. 159). Role stress is external to the person and originates in their social structure. It can consist of role ambiguity, role conflict, role incongruity, role overload, and role qualification (Hardy & Conway, 1988). The second environment refers to the psychological environment and includes the perceived demands and internalized sensitivity toward co-workers, supervisors, administrators, patients, etc. This creates role strain which is intrinsic, consisting of “subjective feelings, frustration, tension, or anxiety” regarding the responsibilities inherent in a particular position which possesses one or more of the aforementioned role stressors (Hardy & Conway, 1988, p. 159). Role strain may also become apparent when the external role stressors become internalized in some fashion. Goode (1960) defined role strain as the “felt difficulty in meeting one’s role obligations” (p. 483). This seems to imply that once role stressors and difficulties are internalized and felt by the role occupant, they then create role strain. Five psychological responses to role strain have been empirically examined and identified as: anxiety, tension, irritation, resentment, and depression (Hardy & Conway, 1988). Facets and Sources of Role Complexities Role complexities are becoming more prevalent and complex with multiple obligations present in the workplace (Hardy & Conway, 1988). Analysis of role theory and research literature has provided further delineation of role theory in general and role stress / strain specifically (Hardy & Conway, 1988). These authors have created the most common, influential, and frequently researched facets of role complexities found
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24 in the literature. The following typologies of role complexity are the result of their seminal work. Role Conflict Role conflict has been described as the “condition in which the focal person perceives existing role expectations as being contradictory or mutually exclusive” (Hardy & Conway, 1988, p. 203). Numerous studies have examined role conflict of individuals working in the health care professions (Acorn, 1991; Coverman, 1989; Decker, 1986; Kopala, 1994; Pilkington & Wood, 1986). Acorn (1991) researched the role conflict and role ambiguity of joint appointed nurses, who had responsibilities in both the academic and clinical settings. In this study, a survey instrument was sent to five Canadian universities that employed joint appointed nurses and data was collected regarding role conflict, role ambiguity, job satisfaction, social support, scholarly productivity, and propensity to leave. The author found that “multiple role involvement does not necessarily lead to role conflict or ambiguity” (p. 325), and that role conflict was more prevalent than role ambiguity. However, both had an adverse affect on job satisfaction and a propensity to leave that particular employment setting. The author also suggested that social support from administration and peers was a way to lessen the detrimental effects of role conflict and ambiguity. In another study, Pilkington and Wood (1986) examined job satisfaction, role conflict, and role ambiguity at a large teaching hospital in Australia. The authors examined staff in full time, permanent part time, and casual part time positions. Their study did not allow a generalization to the greater population, but did suggest that high levels of role conflict may be related to decreased levels of job satisfaction, which in
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25 turn, is related to a greater propensity to leave. However, high levels of role conflict and role ambiguity, did not directly relate to propensity to leave. Both of the aforementioned studies used the scale constructed by Rizzo, House, and Lirtzman (1970) to measure role conflict and role ambiguity. This scale measures role conflict between role behavior or job expectations, and the following items: time, resources, internal standards and values, multiple roles, incompatible policies, conflicting requests and incompatible standards of evaluation. Role ambiguity was measured using items that reflect an inability to predict the responses of others and lack of clarity regarding job expectations (Pilkington & Wood, 1986). Role Ambiguity Role ambiguity is described as situations in which the norms for a particular position are vague, unclear, ill defined, or consist of contradictory role expectations. Role ambiguity is also associated with poorly defined expectations, haphazard performance, and inconsistent discipline or evaluations (Hardy & Conway, 1988). Pilkington and Wood (1986) found that the levels of role ambiguity were highest amongst the casual group of nurses they studied. These findings were expected, since the casual worker typically is not stationed in one particular area of the hospital, creating a foundation for unclear expectations regarding issues with authority, evaluation, and responsibilities (Pilkington & Wood, 1986). Role Overload Role overload refers to a condition when an employee finds it difficult to perform job duties because they are either excessive or cannot possibly be finished in the time available. Coverman (1989) describes role overload as “fulfilling several roles
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26 simultaneously” and states that role overload leads to role conflict when one of the roles disallows the employee from performing the duties required of their other roles (p. 967). Hardy and Conway (1988) have defined role overload as when an individual is able to finish all o f the obligations, but not at a level of competence otherwise achieved if other duties were not present. Therefore, there are two components of role overload: quantitative and qualitative. Quantitative overload refers to the fact that the role occupant has too many tasks to perform and not enough time to perform them. Qualitative overload refers to work that is too difficult, complex, or intense and therefore the quality of work suffers. Qualitative overload is closely related to role under-qualification in which the role occupant does not have the skills necessary to handle his / her job responsibilities (Hardy & Conway, 1988). Hardy and Conway (1988) also discuss role under-load, in which insufficient demands are placed on an individual’s time and thus the individual is not challenged to perform to his or her level of capabilities. They feel that role overload could possibly be the major source of role complexities amongst health professionals. Role Incongruity Role incongruity describes situations where incompatibility occurs between either skills or personal values and the job requirements. It is not a well researched or defined concept in the literature, but it refers to situations where the competence, ability, morality, self-perception, preference, or expectations of a professional might not align well with the requirements of a particular role (Hardy & Conway, 1988).
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27 Role Competence / Incompetence Role competence/incompetence refers to an individual’s overall ability to perform successfully in their current roles. Role incompetence describes a situation in which an individual does not have the necessary skills or knowledge to successfully perform the responsibilities inherent in a particular job. Role competence, on the other hand, describes a situation where the role occupant does have the social, mental, and physical abilities to perform well within his/her particular job. It has been agreed upon /
by structural theorists that role competence is necessary to adequately perform a role, and to progress and develop both individually and socially. Role competence can be a learned behavior, developed through the socialization and acclimatization process at a place of employment (Hardy & Conway, 1988). Role Qualification Role qualification can be examined as either under-qualification or overqualification. In the case of role under-qualification, the role occupant is overwhelmed by the amount of work responsibilities and obligations that need to be performed. These feelings are based on the fact that the professional is neither qualified nor able to perform the tasks in a timely manner. Role under-qualification can also lead to feelings of role overload. Role over-qualification occurs when individuals are over qualified and able to perform work much more difficult than what is being asked of them, causing undemtilization and frustration (Hardy & Conway, 1988). Taking all of the aforementioned typologies into account is important when studying role complexities. Individual typologies alone may create role complexity in given situations, but many of the typologies are found to intermingle, compound, and
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28 create overall role stress / strain. Therefore it is essential to the understanding of role complexities that they are studied both individually and collectively as both sources may create stress for a role occupant. Role Complexities in Health Care Professions Role complexities are a concern in many allied health professions, including nursing, medicine, physical therapy, and athletic training. There have been numerous studies on role complexities in the nursing and health care literature. Lambert and Lambert (2001) performed an international literature review of role stress/strain on nurses using MEDLINE, and found over 100 articles from 17 different countries, published since 1990. Most of these studies examined the typologies of role complexities set forth by Hardy and Conway (1988). Even with the large number of studies already undertaken, the examination of these issues remains current and ongoing in the ever-changing arena that many allied health professionals are employed in (Lambert & Lambert, 2001). Langan (2003) utilized a convenience sample of four nursing schools, two of which expected faculty to perform clinical practice, and two of which did not. The participants included both nursing faculty from the school as well as staff nurses from the hospitals in which student clinical instruction took place. These individuals had to collaborate to deliver both classroom and clinical instruction. Data collection methods included survey/questionnaires and focus groups. Role conflict, role overload, and role ambiguity were found amongst both groups. The amount of role complexity varied, and was dependent on the situation and employment settings the individual found himself/herself in. The authors concluded that in order to eliminate the levels of the
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29 expressed role complexities, the role expectations must be reviewed, communicated, and reinforced. An article by Rutter, Herzberg, and Paice (2002) explained that doctors and dentists also experience role complexities in their workplace. The inherent stress of dealing with people who have health issues is often compounded by the stress of additional responsibilities of teaching and training students and interns. When an individual takes on the additional role of teaching or clinical instruction the ever changing curricular demands are time consuming and create the potential for role complexities (Papp & Aron, 2000). The educational roles held by staff nurses, faculty practitioners, or clinical practitioners in the health professions are similar to those found in athletic training at the collegiate level. Correlations can be made amongst many professions that require both didactic and clinical education, and the parallel is made easier when the subject matter is similar, as is the case within many health care fields. Faculty Role complexities have been examined in traditional academic faculty as well as medical faculty. In fact, regarding medical education, Papp (2000) stated, “the single greatest problem facing the professorate is the tension between teaching and research” (p. 409). Mobily (1991) examined role stress in nurse faculty and found that there were conflicting obligations related to the three major job responsibilities of academic faculty; teaching, research, and service. For some this may be the position that they would choose and enjoy, whereas others might find these positions seasoned with conflict and strain (Fain, 1990).
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30 Faculty positions can create role complexity issues due to the teaching, research, and service responsibilities of traditional classroom and clinical instruction. Williams and Hadfield (2003) found that athletic training education programs that have faculty who do not share clinical and teaching responsibilities produce graduates with a higher first-time passing rate on the national certification exam. It was felt that this was due to the fact that the faculty member would have more time to prepare for classroom teaching and perform academic duties than a joint appointee with responsibilities to both academics and clinical practice. Clinicians Role complexities also occur in traditional clinicians, who practice health care in various settings. In this setting the role complexities originate from multiple sources including, but not limited to patient care, continuing education, professional service, and student instruction (Mobily, 1991). Dividing time between personal continuing education and mastery of skills along with the multiple responsibilities toward clinical education of health profession students can be fraught with difficulty. Oerman (1998) found that clinical nursing faculty experienced role strain, due to the various demands of student learning, development of skills, balancing the needs of students and clinical site coordinators, clinical teaching of unprepared students, and student supervision. Ryska (2002) examined administrators in athletic settings and determined that administrators, and athletic trainers, possess multiple areas of responsibility creating a situation where role complexities may be present. Thus, research has shown that there is the potential for multiple sources of contributing factors toward role complexities
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31 amongst the responsibilities of clinical work, administration of programs, and clinical instruction. Joint Appointees Joint appointment health care professionals are often expected to perform and be evaluated on the traditional academic faculty job responsibilities, and maintain competence in clinical practice (Mobily, 1987). Broussard, Delahoussaye, and Poirrier (1996) feel that a recent influx of joint appointment positions in nursing are due to growing pressure from peers, administrators, students, and nursing faculty encouraging active participation in clinical practice as a way to improve the learning outcomes of the students in academic nursing programs. Langan (2003) researched the perceptions of staff nurses, clinical nurses, and administrators to analyze feelings regarding student nurse education. In an in-depth focus group study they found that all participants in the study felt that faculty clinical practice (joint appointment) was valuable. Beitz and Heinzer (2000) wrote that faculty practice should be looked upon as a positive way for faculty to stay in touch with the climate in which the students will eventually gain employment. The authors also found that in order for joint appointments to be successful the employee and administration must have the following: mutual accountability; the perception that both roles are important factors for the single identity; compatible role expectations; and understanding about how the clinical practice portion of the position will affect tenure and promotion. Poor communication and unclear role delineation has been found to create role complexities among health care professionals, practitioners, faculty, patients, and administrators (Langan, 2003). Joint appointments will most likely fail when an individual is accountable to two
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32 separate administrative bodies or when a lack of respect for clinical practice, research, teaching, or publishing exists (Beitz & Heinzer, 2000). In 1990, Acorn undertook a study of the facets of role complexity experienced by joint appointed nursing faculty and found that role conflict was more prevalent than role ambiguity, but both factors lead to decreased job satisfaction and a propensity to leave the job. Steele (1991) assessed the main problem between joint appointees as occurring when faculty/clinicians attempt to balance teaching and practice responsibilities. She noted that when multiple role demands exist, a common way of dealing with them is to create a hierarchy of responsibilities based upon a determination of perceived importance. This reinforced the work of O’Shea (1985) who examined the role orientation of nurse faculty between their roles of patient care and clinical supervision of students and found that there was a tendency of the role occupant to perceive one role as more important than another. Many other authors have conducted studies examining the academic and clinical roles and responsibilities involved in joint appointments (Broussard, Delahoussaye, & Poirrier, 1996; Langan, 2003; Kopala, 1994; Myrick, 1991; Myrick & Barrett, 1994; Oermann, 1998; Pilkington & Wood, 1986; Piscopo, 1994). Other studies have been undertaken in an attempt to understand the main cause of role complexities, and what the contributing factors are for nurse faculty, practitioners, and students (Mobily, 1991; Oermann, 1998). Responsibilities to research, teaching, service, continuing education, student advising, administrative duties, and professional organizations are among the many sources of potential role complexities (Mobily, 1981). Oermann (1998) states that if a clinical faculty member is to be successful, he or she must be able to manage the
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33 stress arising from “responsibilities for promoting student learning and development of skills for practice in light of the limited time for clinical instmction; balancing the needs of students, clients, and agency personnel; teaching students who might be unprepared for the clinical experience; and supervising student experiences in newer types of health care settings” (p. 329). If an individual is to succeed in such joint appointments, Langner and Wolf (1996) feel that the person “needs to be an individual who is able to move between academic and clinical worlds, someone who is tenacious, perseveres in rapidly changing organizational climates, is able to say “no,” and who remains convinced of the value and synchrony of research and practice” (p. 49). Settles, Settles, and Damas (2002) examined the role complexities of student / athletes at the collegiate level in a setting similar to that in which the athletic trainer might work. They examined the perceptions of individual student / athletes with regard to role separation and role interference in an attempt to further define the typologies of role conflict and overload. Results showed that if students conceptualize their roles as being independent of each other they were less likely to exhibit feelings of role conflict or overload. Settles, et al. (2002) make the claim that individuals with multiple roles are able to cognitively and physically separate the roles and disallow them from interfering; they are less likely to exhibit the role complexities that researchers might expect. However, as the old adage says, this might be easier said than done especially in situations where clinical instruction is a vital and important role obligation. This might be applicable to the individual who teaches in the classroom, but becomes more difficult for the clinical instructor; separating clinical care and clinical teaching moments can
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34 prove to be complicated. This creates role issues for the joint appointed professional or clinical instructor in physically separating their roles. The role of teacher and coach may also have some similarities to the joint appointed collegiate athletic trainer. Individuals in these positions have combinations of academic and athletic responsibilities similar to those of the joint appointed athletic trainer. The role complexities of the teacher/coach have been previously studied (Decker, 1986; Massengale, 1977, 1981, 1994). In a study examining the role conflict of teacher/coaches at small colleges, Decker (1986) found such individuals overall experienced minimal amounts of role conflict. However, the author went on to state that it was felt that institutional or individual factors are intimately involved with the amount of experienced role conflict and that at small institutions, the individual factors often are more influential than the administrative ones. In the cases where an individual preferred only one role, there was a higher amount of inter-sender role conflict and it was felt that one individual who was superordinate in nature and was creating unreasonable performance expectations created the conflict. Massengale (1981) states that the role conflict in teacher/coach joint appointments is often exacerbated by the clash between the individual’s upwardly mobile career aspirations in coaching and incompatible expectations from academics. He believes that athletics are often at the center of this conflict. Imprecise role definitions, poorly defined reward systems, and socialization issues are also contributors to the role conflict amongst joint appointed individuals (Massengale, 1981).
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35 Role Orientation In addition to the role complexities and the multiple typologies that make up that construct for faculty, clinicians, and joint appointees, there is also the issue of role orientation. Each of the typologies of role complexity may occur in every one of the specific employment settings described previously. Role orientation occurs when two or more roles exist and should be examined with role complexity. O’ Shea (1981) described role orientation as the individually chosen predominate role which occurs when choices or demands are made regarding the amount of time, effort, and energy placed into a particular role. Ruby (1998), in a discussion about faculty, stated that people make their role orientation regarding teaching, scholarship, and service clear to all by the amount of time they attribute to each task. Steele (1991) assessed the main problem between joint appointees as occurring when faculty/clinicians attempt to balance teaching and practice responsibilities. She noted that when multiple role demands exist, a common way of dealing with them is to create a hierarchy of responsibilities based upon a determination of perceived importance. This same principle can be applied to the various individual responsibilities of a clinician. The potential exists for an individual to posses a role orientation hierarchy amongst the roles o f their joint appointment. Choices will be made regarding which of the roles will become predominate and engage our time, talent, and attention. Job Satisfaction Job satisfaction has been described how individuals feel about their entire job or the different individual aspects of it (Spector, 1997). Milton and Entrekin (1984), discuss job satisfaction by saying:
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36 While many factors affect job satisfaction, two kinds of perceptions - what should be and what actually is - are instrumental in determining satisfaction or dissatisfaction. The perception of conditions that should exist is the result of one’s needs and values, prior job experiences, current social comparisons with others, and reference group influences that shape standards or criteria. The perception of actual job conditions, such as compensation, supervision, and work itself, provides a basis for comparison with what should be. (p. 171) This definition describes the theoretical framework of an individual’s job satisfaction as being an emotion or attitude. The literature has historically described job satisfaction in this way, both in response to the job as a whole or specific aspects of it (Locke, 1976; Smith, Kendall, &Hulin, 1969; Spector, 1997). The predominant method of current research regarding job satisfaction is to evaluate the cognitive aspects and processes, whereas previous research focused on physical and psychological need fulfillment (Spector, 1997). General measures of job satisfaction are typically examined by either global or composite/facet scales (Ironson, et al., 1989). Global scales ask respondents to react to multiple aspects of their jobs in one single response (Ironson, et al., 1989). The global scale is beneficial when attempting to ascertain overall perceptions regarding job satisfaction. In contrast, the composite or facet scale approach asks respondents to answer multiple questions pertaining to specific aspects of their jobs. The composite / facet scale approach is useful in determining what aspect of the job causes the occupant the most amount of satisfaction or dissatisfaction and almost serves as a post hoc analysis (Spector, 1997). Common facets examined in composite/facet job satisfaction studies include appreciation, communication, coworkers, fringe benefits, job conditions, nature of work, organization itself, organizational policies and procedures, pay, personal growth, promotion opportunities, recognition, security, and supervision (Spector, 1997).
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37 Role Complexities and Job Satisfaction of Health Care Professionals Role complexities in the health care professions have been shown to affect job satisfaction thus providing a related body of knowledge to the current situation in athletic training (Acorn, 1991; Barrett & Myrick, 1998; Deckard & Present, 1989; Fain, 1987; Pilkington & Wood, 1986; Simpson, 1985; Spector, 1985; Stamps, Piedmont, Slavitt, & Haase, 1978). Acorn (1991) determined that higher levels of role complexity facets had an adverse affect on job satisfaction. Fain (1987) also reported that role strain was negatively related to job satisfaction, supporting the previous work o f Kahn et al. (1964). In a study of physical therapists, Deckard and Present (1989) found that role conflict and ambiguity were strongly associated with job-induced tension (r = .58). As higher levels of role ambiguity, role stress, and organizational conflict occurred they noted a decrease in personal well-being and an increase in job induced tension. Left unfettered these issues may manifest themselves “in self initiated role conflict as one’s attitudes and behaviors prove inconsistent with the esteemed values of teamwork, sensitivity, and compassion” (p. 718). Simpson (1985) conducted a study that found a high level of job dissatisfaction among nurses and felt that administrative steps to correct the main causative factors of the dissatisfaction would improve productivity, absenteeism, and competence. Pilkington and Wood (1986) studied job satisfaction, role conflict, and role ambiguity of hospital nurses in Australia. Their results showed that higher levels of role conflict are associated with higher levels of job dissatisfaction and thus an increased propensity to leave. Barrett and Myrick (1998) studied the relationship between job satisfaction of students in clinical experiences and their performance. They found a direct positive
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38 correlation between the amount of job satisfaction and the following five areas: leadership (r = .40), critical care (r = .38), teaching / collaboration (r = .49), planning / evaluation (r = .57), and interpersonal relationships / communication (r = .41). This would indicate that the performances of students in a clinical instruction experience are affected by overall satisfaction, and implying that work performance is related to job satisfaction. There are numerous studies that have shown how role complexities affect job satisfaction and propensity to leave within the health care professions. When role complexity is present it often affects job satisfaction with potentially devastating effects on the health care delivery system. Stressors due to constraints and restrictions of time, energy, money, and talent should be eliminated in an attempt to establish a framework where appropriate medical care is given to patients. Therefore, it is appropriate to measure these two constructs together due to the direct relational nature that role complexities have on job satisfaction. Summary Role complexities are present in all aspects of life. The balance between work, social, spiritual, family, and other obligations can often be described as tenuous, and can contribute to role complexities affecting satisfaction levels. Research on role complexity issues and typologies has been performed previously in many settings (Goode, 1960; Hardy & Conway, 1988; Kahn et al., 1964; Rizzo et al., 1970). Specific role complexity research amongst health care professionals has also taken place, but none has been performed in the allied health care field of athletic training (Lambert & Lambert, 2001). This quantitative study begins a line of research examining the role
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complexities of certified athletic trainers employed at institutions of higher education. It examined how and if role complexities affect the job satisfaction and propensity to leave the profession of such individuals. Expanding the previous role complexity and job satisfaction research into this area serves to enlighten those who currently are, and those who wish to become employed in this career field.
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40 CHAPTER 3: METHODOLOGY The intent of the study was to examine the issue of role complexity for college ATCs. This study also evaluated feelings of job satisfaction and intent to leave current job / profession and whether these feelings can be attributed to role complexities. The research design for the study was quantitative in nature and involved a survey that gathered information regarding demographics, role orientation, role complexities, and job satisfaction. A survey was chosen because by definition it is an appropriate instrument for obtaining numeric descriptions of trends, opinions, feelings, beliefs, and attitudes, and allows for some generalization about a population (Creswell, 2003). Portions of the survey were modified from an existing survey instrument used to evaluate components of role complexity for nurse faculty (Mobily, 1987). Written and oral permission to make modifications were received from the author o f the original instrument. Efforts were made to create an instrument that was more applicable to this study and its population. This chapter will describe the methodology, data collection, and data analysis used in the study. A procedural pilot study was conducted in order to facilitate more accurate instrumentation and procedural methodology for this study. That process and its resulting instrument changes will be described first. Pilot Study and Instrument Calibration The purpose of the pilot study was to test and evaluate the survey instrument to be used in the larger proposed study examining role orientation, role complexities, and job satisfaction of college certified athletic trainers. The data collected during the pilot study was sequestered from the actual study data and only used to evaluate the
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41 instrumentation and research procedures. Pilot study data were not used in the proposed research. The surveys for the pilot study were sent to a convenience sample o f 17 potential respondents, who were asked to complete a questionnaire and offer feedback on question content and direction clarity. This feedback was used to make changes to the instrument in an attempt to improve overall clarity and appropriateness for the population studied. Descriptive and variable reliability statistics were performed on the data, and the final instrument was created through a combination of participant feedback, statistical analysis, and reflection on appropriateness of questions. The pilot study instrument used fill in the blank, choice identification, and Likert - type scale responses. The instrument consisted of four sections: demographics, role orientation, role complexities, and job satisfaction. The demographic and job satisfaction sections of the instrument were created by the principal investigator using questions that would obtain information that was felt to be important in answering the research questions. The role orientation and role complexity sections were modifications o f an instrument created and used by Mobily (1987) in her doctoral dissertation at the University of Iowa. She used the instrument to examine the socialization, role orientation, and role strain of university nurse faculty. The role orientation section was used in its original form, except for some minor wording amendments, which facilitated the change in content from the field of nursing to athletic training. The role complexity portion was a modification of Mobily’s “role strain” section. Changes were made in this section prior to the pilot study in an attempt to make the survey more applicable to athletic training.
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42 Following an examination of the data collected from the pilot study and the feedback from the respondents, changes were made to the instrument to enhance question clarity and content validity. Questions were also removed due to their non applicability in facilitation of answering the research questions. Details of the changes made are outlined in the following sections. The final survey instrument can be found in Appendix B. Demographics Questions in this section of the survey dealt with institutional affiliation and division such as National Collegiate Athletic Association (NCAA) or National Association of Intercollegiate Athletics (NAIA). The number of years of NAT A certification, age, highest academic degree, current institutional responsibilities, number of years at current job, and whether the institution offered an ATEP were obtained. Gender, marital status, and number / ages of children questions that were asked in the pilot study were removed after it was determined they were not germane to the research questions regarding professional role complexity. Role Orientation Role orientation was examined using the role orientation survey created by Mobily (1987). The instrument was originally used to determine the amount of emphasis a nurse faculty member placed on each of the three most common faculty responsibilities: teaching, service and research. This aspect of the survey was slightly modified, with permission, to make the service portion of the instrument reflect not only the traditional role of academic, professional, and community service but also to reflect the clinical component of a certified athletic trainer working with the athletic teams.
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43 Emphasizing or de-emphasizing each element of responsibility created eight different role orientation typologies relating to teaching, service, and research. These typologies emphasized a role independently or in combination with another role. In the pilot study respondents were asked to relate their beliefs about their ideal and actual role orientations, the role orientation that was most like that of the mission or the institution, the role orientation that was encouraged / promoted by supervisors, the role orientation that was most appropriate for the athletic training profession, and the role orientation that best described the norms/values of both the majority of, as well as, their most respected colleagues. The respondents answered these questions by marking the most appropriate description o f their role orientation. The respondents were also asked to approximate the percent of time they actually spent in each of these roles, and what percent of time they would ideally like to spend. These questions were answered via a fill in the blank format as a percentage of their work time. After examination of the pilot study responses the role orientation section of the instrument was changed to include a category for administrative responsibilities. By adding an additional category to the role typologies, the role orientation survey was expanded from 8 to 16 different typologies. Although this change made the list of typologies longer, it was felt that the additional benefits of obtaining more accurate information outweighed the slight inconvenience of a lengthened list. In addition, several questions that the respondent might not have adequate information to answer were removed in order to refine the role orientation section. The questions removed included inquiries about institutional mission, norms/values of colleagues, and
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44 orientation of most respected colleagues. A total of four questions were asked in this section. Role Complexity Role complexity was examined using the Role Strain Scale developed by Mobily (1987). This aspect of the survey consisted of 44 questions that addressed the role complexity issues of role conflict (inter-sender, intra-sender, and inter-role), role ambiguity, role overload, role incongruity, and role incompetence. The term sender, which is used to describe role conflict, refers to either the individual themselves in intra-sender, or others in the case of inter-sender. It refers to the person who is creating or sending the conflicting role expectations. This might be the individual themselves as they internalize the conflict between work and family obligations or two or more individuals at the workplace who are sending conflicting messages regarding responsibilities and expectations. The respondents used a five point Likert -type scale (l=never, 2=rarely, 3=sometimes, 4=often, 5=nearly all the time) to answer how often specific work related situations created stress for them. Questions from the role complexity section of the pilot study were grouped together by question direction, content, and format in order to obtain a mean score for the different typologies of role complexity. The questions were scored on a scale of 1 to 5 with a score of one meaning a low stress value and ascending to a high stress value of five. The following role complexities were evaluated and the individual questions that were averaged together to create the role typology scores are described below:
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45 Role conflict. The mean score of questions 4, 5, 6, 8, 9, 15, 16, 17, 21, 25, 26, 27, 28, 32, 33, 42, 43 and 44 of the role complexity section of the survey was used to determine the role conflict value. Inter - sender conflict. The mean score of questions 15, 32, 33, and 44 of the role complexity section of the survey was used to determine the inter-sender conflict value. Intra - sender conflict. The mean score of questions 5, 6, 8, 9, 16, 17, 21, 25, 42 and 43 o f the role complexity section of the survey was used to determine the intra sender conflict value. Inter - role conflict. The mean score of questions 4, 26, 27 and 28 of the role complexity section of the survey was used to determine the inter-role conflict value. Role ambiguity. The mean score of questions 20, 22, 31, 39, 40 and 41 of the role complexity section of the survey was used to determine the role ambiguity value. Role overload. The mean score of questions 1, 2, 3, 10, 18, 23, 29, and 30 of the role complexity section of the survey was used to determine the role overload value. Role incongruity. The mean score of questions 7,11,12, 13, 14, 19 and 24 of the role complexity section o f the survey was used to determine the role incongruity value. Role incompetence. The mean score of questions 34, 35, 36, 37 and 38 of the role complexity section of the survey was used to determine the role incompetence value. Reliability of the Role Complexity Scale used in the pilot study was measured by performing a confirmatory factor analysis. The test procedure was performed and an alpha coefficient was obtained to determine scale reliability and consistency amongst
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46 the questions on the survey. This procedure assisted in determining if a particular question or questions are not applicable and should be excluded from the composite variable. After examination of the statistics and review of the questions it was determined that several questions should be removed from the role incongruity and role incompetence typologies. This decision was based on two reasons. First, their applicability to the population examined in the pilot study and to be studied in the larger research project was questioned. The questions dealt with issues specifically related to nursing and their applicability to athletic training was minimal. The second reason was that upon removal from consideration in the reliability analysis the alpha coefficients were much improved. Role incongruity reliability analysis alpha coefficient improved from .418 to .607 upon removal of questions numbered 7, 11, and 13, which were felt to have nominal applicability to the study and its research questions. Role incompetence reliability analysis alpha coefficient was improved from .348 to .602 upon the removal of question number 35, which was felt to not be applicable to role incompetence. In addition, a role conflict scale was evaluated on the data from the pilot study and consisted of 18 items from the inter-sender, intra-sender, and inter-role conflict scales. Alterations to the Role Complexity Scale used in the pilot study were made following feedback and further statistical examination of the data. Several questions were removed during the variable reliability analysis to improve the alpha coefficients. However, rather than completely remove them from the instrument; a new category of “not applicable” was created in order to assist the respondent in more accurately answering the questions. In situations where the respondent felt the question did not apply to their situation, they had the option of not answering the question, thus not
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47 confounding the data with an answer that was given just for the sake of answering. This allowed non - responses to be purged from the statistical analysis for the corresponding role complexity typology variable. An additional question was added to the instrument that addressed administrative role expectations and was included in the inter-role conflict scale. This was in response to the creation of an administrative role typology for the Role Orientation Section. Since the respondents felt that there was a need to add this job responsibility to the Role Orientation Scale it is appropriate to include a question regarding the stress that occurs from administrative responsibilities in the Role Complexity Survey. Questions 21 and 22 were removed from the original survey due to lack of clarity and non-applicability to the target survey population. There were numerous responses from the pilot study population about concerns and applicability of these particular questions. Question 21 was originally a role ambiguity scale item, but the new question is now an intra-sender conflict scale item. The wording and content of question 22 was changed but will remain part of the role ambiguity scale. Other changes were made in the wording of questions in order to improve their consistency to the language spoken among those involved in the field of athletic training. Care was taken to not alter the intent of the question in any way, thus allowing the questions to remain in the specific role complexity typology as delineated in the original Role Strain Scale (Mobily, 1987). The role complexity section of the final instrument consisted of 45 items.
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48 Job Satisfaction A series of questions relating to job satisfaction was created for the pilot study. It consisted of questions dealing with overall job satisfaction, facets of job satisfaction, and intent / propensity to leave the job or profession. The respondents were asked to respond to the questions dealing with job satisfaction on a seven point Likert - type scale (strongly disagree, disagree, slightly disagree, neither agree or disagree, slightly agree, agree, and strongly agree). Specific questions required the respondents to examine their feelings about overall job satisfaction, in addition to more specific questioning that addressed compensation, colleagues, supervision, and expectations. The respondents were also asked to reflect upon and answer questions regarding intent to leave their current position and / or profession. After examining the data received from the pilot study and further contemplation of study intent, this section was changed dramatically. Since the study was largely undertaken to examine role complexity and how it affects job satisfaction and intent to leave, the decision was made to assume a more global approach to job satisfaction. In order to force the respondents to answer the questions asked in this section, the “not applicable” response was removed. A more inclusive and global question of “I am satisfied with my professional position” was used to address job satisfaction. The likert-type response scale for this question consisted of the following six options: Strongly disagree, disagree, slightly disagree, slightly agree, agree, and strongly agree. In addition, two intent / propensity to leave questions were asked. One queried how often in the past year the respondents had thought about leaving their current
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49 professional positions and the other inquired about how often in the past year the respondents contemplated leaving the profession of athletic training. The likert-type response scale for these questions consisted of the following four options: never, seldom, occasionally, and frequently. Study Sample and Data Collection The sample for the actual study was drawn from collegiate ATCs employed at four-year colleges and universities. A random sample of e-mail addresses for 1,000 individuals who met the study criteria of being employed at a four-year college or university was obtained from the National Athletic Trainers Association national office and sent to the assistant director of the Frost Research Center at Hope College. Upon receipt o f these e-mails the assistant director assigned a number and password to each potential respondent and was responsible for dissemination of study correspondence in an attempt to assist with confidentiality of data. On July 25th, 2005 the initial e-mail invitation to participate was sent to all members of the sample population. Several days later she sent a reminder to those who had not responded to the initial invitation. A second reminder was sent to those who still had not responded approximately 10 days after the initial invitation. Survey collection was complete 14 days after the initial email was sent. Copies of the letters inviting the sample population to participate in the survey are found in Appendix C. Responses to the survey were held in reserve by the host site software and downloaded by the assistant director into a data file for analysis. A copy of the original data set was saved on a data storage device, given to the principal investigator, and stored in a locked cabinet.
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50 Data collection occurred using a web-based host site where respondents used an Internet link to obtain a copy of the survey. When a respondent decided to participate, they completed and submitted the survey electronically. Responses were held in reserve by the site host and collected by the principle researcher for analysis at the end of the data collection period. A data file of the responses was created using the Statistical Package for the Social Sciences (SPSS, version 12.0.1; SPSS Inc., Chicago, II). Descriptive statistics were calculated for the demographic, role orientation, role complexity, job satisfaction, and intent to leave sections of the study. Variables were created to group respondents into professional role categories and others to facilitate statistical analysis. Variables for the specific role complexity typologies were also created in accordance to the aforementioned role complexity groupings. Inferential statistics, including correlation studies, ANOVAs, and regression analysis were performed to determine relationships amongst variables. Limitations of Study Some of the limitations for this study were addressed through the implementation of a procedural pilot study. However, a few still remain. This study examines role complexities that originate largely at the workplace. As previously mentioned, role complexities occur whenever two or more obligations conflict. This particular study examines professional role complexity and does not address the role difficulties originating with family, social, spiritual, or other aspects of life. Another limitation of this study included the efficacy of survey distribution. There were some difficulties with getting the survey past e-mail and Internet protective software on the
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51 various campuses of the respondents. Even though the surveys were sent out in small batches they were large enough to trigger protective software on the second and third waves of mailings and returned marked as “spam.” Efforts were made to resend the surveys at a later time and they seemed to reach their intended recipients. However, with any research that involves mailings, either by hand or electronically, there remains the concern if whether the survey actually reaches its intended recipient. An additional limitation was the timing of the actual survey. Automatic replies from numerous individuals stating they were unavailable and on vacation were received. However, it was felt that this time of the year was better for response to the survey before the workload increased for the respondents during the school year. This was an informed decision and if it was a limitation it was felt to be minor as any time of year has limitations regarding availability and willingness to participate in a survey. Follow-up with non-respondents was not undertaken during this study. It was felt that a follow-up questionnaire or phone call would violate assumptions regarding confidentiality and anonymity for this study. However, this decision was made with full knowledge that it could not be accurately determined whether the non-respondents differed from the respondents with respect to demographic information or role complexity and job satisfaction values. Summary This study of role complexities for collegiate athletic trainers was quantitative in nature and involved a web-based survey. Analysis of the data occurred using the Statistical Package for the Social Sciences (version 12.0.1; SPSS Inc., Chicago, II) and is described in the next chapter. Variables for demographic information, role
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orientation, role complexity, job satisfaction, and intent to leave were created. Additional variables for the specific role complexity typologies were also created based on question direction, content, and format in order to obtain a mean score for the different typologies of role complexity. Descriptive statistics of the demographic information were compiled and reported. Inferential statistics including correlation studies, ANOVAs, and regression analysis were performed to determine relationships amongst variables.
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53 CHAPTER 4: RESULTS This chapter presents the results of the statistical analysis performed on the survey responses. In order to answer the research questions that guided the study, the following statistical analyses were performed to examine the demographics of the sample and the three overarching study questions. Descriptive statistics of the study sample are reported, examined, and compared to the national population. A frequency examination of the responses to primary role responsibility and role orientation questions was undertaken and reported. Examination of the mean role complexity typology values was performed in an attempt to determine the source of felt role complexities among the study respondents. In addition, ANOVA procedures were run to detect any differences in role complexity, job satisfaction, and intent to leave among the respondents’ primary professional role responsibilities and the study population as a whole. Finally, means, standard deviations, Pearson correlation coefficients, and multiple regression analyses were employed to examine the degree of relationship between the independent variables of role complexity typologies and the dependent variables of job satisfaction, intent to leave the job, or intent to leave the profession among the groups created according to professional role, study population, and various demographic variable categories. The manner of presentation of the statistical analysis is as follows: demographics, role orientation analysis, role complexity analysis, differences among the professional role groups in felt role complexities, differences among the professional role groups in job satisfaction and intent to leave, and relationships between role
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54 complexities, job satisfaction, and intent to leave. A priori alpha levels for statistical significance were set at .05 where appropriate. Demographics Surveys were sent out to a random sample of 1,000 collegiate athletic trainers across the nation. Twenty-one of these potential respondents were subsequently removed from the random sample for the following reasons: nine possessed undeliverable e-mail addresses, three asked to be removed, three were not working in athletic training at the college level, two were from a two-year institution, two were out of the office during the data collection process, one was unavailable due to health reasons, and one survey was sent to the investigator. A total of 356 responses were received but upon closer examination eight of these responses were removed. Four were removed due to affiliation with two-year junior colleges and four respondents provided partial responses to the survey instrument and thus were removed due to significant amounts o f missing data. Therefore 348 usable responses with no missing data points were received out of a possible 971, which constitutes a 36% response rate. Although the response rate is somewhat low, the study participants are quite representative of the entire population as determined by a comparison of the study sample and demographic data gathered from the national office of the National Athletic Trainer’s Association. When categorized according to institutional affiliation, institutional division, age, highest degree held and primary position, only the NAIA respondents aged 23 to 30 and the NCAA Division I head athletic trainers possessed more than a 10% discrepancy when compared to the national data. The discrepancy was 13% for these two groups in contrast to less than 10% for all other comparative
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55 categories. Descriptive statistics regarding employment according to institutional affiliation and division, age, and highest degree held can be found in Table 1. Table 1 NAT A and Study Population Demographics Variable
NCAA Division I
Population
NATA N(%)
NCAA NCAA Division III Division II Study NATA Study NATA Study N(%) N(%) N(%) N(%) N(%)
NAIA NATA N(%)
Study N(%)
Age 2 3 -3 0
427(35)
66(39)
179(39) 26(38)
251(40) 42(49)
86(39)
13(52)
3 1 -4 0
472(39)
61(36)
184(40) 32(46)
241(38) 29(34)
93(40)
10(40)
4 1 -5 0
215(18)
29(17)
70(15)
8(12)
98(16)
28(12)
2(8)
5 1 -6 0
94(8)
11(7)
21(5)
2(3)
33(5)
6 1 -7 0
7(