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Research article

Transition from Education to the Workplace: A Grounded Theory Investigation of Early Career Athletic Trainers

Christopher J Nightingale EdD, ATC, LAT1*, Barbara Blackstone MS, ATC, LAT2, Stephen A Butterfield, PhD3

1Assistant Professor of Athletic Training and Physical Education, University of Maine, USA
2Coordinator of Athletic Training Education, Chair, College of Professional Programs, Chair, College of Education, University of Maine at Presque Isle
3Emeritus Professor, University of Maine, USA

*Corresponding author: Christopher J Nightingale, EdD, ATC, University of Maine, 5740 Lengyel Hall Rm 115, Orono, ME 04469-5740, USA, Email: christopher.nightingale@maine.edu

Submitted: 07-28-2016 Accepted:  08-29-2016  Published: 09-28-2016

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A better understanding of how novice certified athletic trainers develop autonomy will provide insight into how education programs and employers can prepare new athletic trainers for transition into the field. The objective of this research is to examine early career athletic trainers (those with 1-4 years of experience) about perceptions of their educations and the first year of their careers to gain insight into self-perceived successes and challenges. Utilizing a qualitative, grounded theory design, we interviewed 20 graduates of Commission on Accreditation of Athletic  raining Education (CAATE) approved programs with one to four years of athletic training work experience. Fourteen of our participants were female and six male, collectively they averaged 21+6.9 months of work experience at the time of interview. Interviews followed a semi-structured format, and multiple analyst triangulation and member checks were included as steps to establish data credibility. Participants indicated three important themes. (1) Mentoring is a principal factor in developing positive perceptions about the workplace. (2) Novice professionals that develop comradery with their coworkers report higher levels of satisfaction. (3) Novice professionals believe documentation such as employee handbooks and/or policy and procedures manuals were beneficial and contributed to workplace satisfaction.

Keywords: Mentoring; Early-Career Athletic Trainers; Professional Socialization


Athletic training is a unique healthcare field. Many employers expect that young professionals are capable of making difficult diagnostic and treatment decisions under challenging circumstances, when they pass their certification exam and enter the workforce. Many newly certified athletic trainers find themselves working in environments where they are the only athletic healthcare provider. These athletic trainers may lack for mentoring or other forms of support to make the beginnings of their careers uneventful. There is benefit to learning about the perceptions of early career athletic trainers and their opinions about the beginning of their professional careers.

In other healthcare fields [1-3], investigators have studied the perspectives of the novice professional. Gaining an understanding about how new professionals perceive the beginnings of their career can help reduce early attrition, increase professional satisfaction, and improve patient outcomes. Previous investigations indicate that athletic trainers utilize both formal and informal means as athletic training students become professionally socialized [4-7]. Education programs and employers can develop programming that addresses the needs of newly certified athletic trainers. Well-structured induction into the workforce improves health care by giving early career athletic trainers help to improve their practice and improve their satisfaction with their career choice [8].

The purpose of this study was to examine the opinions and perceptions of early career athletic trainers about their first year of work experience post-certification. For the purposes of this study, investigators decided to define ‘early career athletic trainer’ as someone with one to four years of professional experience. We selected this range because it gives potential participants a minimum of a full year of experience to reflect upon, but also keeps participants close enough to the beginning of their careers to recall specific events and perceptions from the first year accurately. Results could yield information that improves the role transition for novice certified athletic trainers entering the workforce.



The present study was conducted via a qualitative grounded theory approach. Twenty certified athletic trainers (14 female, 6 male) that graduated from five Commission on Accreditation of Athletic Training Education (CAATE) accredited programs were recruited via convenience sampling (via word of mouth between investigators and known associates) and interviewed. Twelve interviews were face-to-face; eight were conducted via telephone due to distance constraints. Interviews typically lasted between 30 and 45 minutes. Inclusion criteria required participants to be graduates of CAATE approved athletic  training education programs with one to four years of professional experience. The minimum experience range was selected so participants would have at least one full year of work experience to reflect upon. The four-year maximum was included so that participants would still be in proximity to their pre-certification educational experiences and first job to remember and reflect upon them clearly. Upon completion of 20 interviews, investigators agreed data saturation had occurred. Appendix A provides participants’ demographic information.

Method of Data Collection

One trained investigator conducted all interviews. Interview questions were developed by both investigators and negotiated
until agreement was reached on each individual question. Participants provided informed consent and agreed to have audio recordings of interviews made and field notes recorded by the interviewer. Both investigators reviewed transcribed recordings and field notes as part of the data analysis. A semi-structured format was utilized to gain information from participants by allowing the interviewer to ask questions from both the interview script, and additional, non-scripted questions to obtain further information. Participants were asked to consider graduate assistant positions that practiced clinical athletic training post certification as their first jobs. Participants were provided with copies of transcripts and field notes to ensure that the interviewer had accurately recorded their statements and were clear about the ideas and perceptions that participants wanted to convey. All aspects of this investigation were conducted under the auspices of the institutional review board of the University of Maine.

Data Analysis and Credibility Procedures

Investigators utilized a qualitative grounded theory approach towards data analysis, seeking to generate theory through inductive strategies [9]. Qualitative research is commonly accepted as viable in athletic training and sports medicine, when
appropriate credibility procedures are followed [5,7,8,20-23]. Initially investigators utilized open coding procedures to develop independent lists of emergent themes in their reviews of interview notes and transcripts. Investigators compared and combined items on the lists and negotiated until consensus was reached about the emergent themes. Independent axial coding by investigators was undertaken next to determine interactions and conceptual linkings between the initial thematic categories. Investigators then negotiated the separate findings to develop unified results. The credibility of the research was attained via data and investigator triangulation (utilizing multiple methods of investigation to strengthen consistency of findings). Basic descriptive statistics were calculated to assist analysis. Investigators agreed that data saturation occurred after 20 interviews. Participant reviews/edits of transcripts, independent investigator review, and investigator consideration of potential areas of bias reduced the likelihood of error.


Three key concepts emerged from the data. Participants indicated that the transition process from student to independent
athletic trainer for early career athletic trainers would be improved by (1) receiving mentoring, (2) developing comradery with peers/coworkers, and (3) having access to written documentation (employee handbooks or policies and procedures manuals). Examples delineating each key point are presented below. Pseudonyms are used in examples to protect identities
of participants and their workplaces.

Importance of Mentoring

The importance of mentoring emerged as a strong theme. Despite graduating from many different educational programs and working in diverse settings, participants consistently indicated a belief that mentoring was beneficial. Participants identified professionals from different roles that served as possible mentors, including supervisors, education program faculty, or past preceptors/supervisors. Those participants that experienced formal mentoring noted it was a meaningful factor in their professional satisfaction. Participants also identified informal mentoring (that not prescribed as a part of their work experience) as useful. Several participants sought out informal mentors, even if mentoring was not officially provided in their workplaces. A small number of participants stated that they had no mentor at all (either formal or informal), but indicated that mentoring would have improved their transition into the workforce.

Barry was a certified athletic trainer that worked at a high school. He spoke of his informal mentoring relationship with his school’s athletic director, and noted that his mentor helped him discover aspects of his job that he had not previously considered. “He has been there with me from the start. He’s helped me a lot. I could always go to him with any questions… he’s always helping me out.” Deana was a graduate assistant athletic trainer that not only participated in a formal program, but sought out additional mentoring. “My mentor was extremely willing to help, but if she was not available, anyone on that athletic training staff was helpful, most of them had been through it before.” Hank’s mentor was his supervisor, and the mentoring relationship began immediately upon being hired. “The first week, it was pretty much my boss and I every morning. We went over policies and procedures. He was integral in helping introduce everyone. He helped me feel more comfortable. It would have been a struggle without him.”

Terry indicated a challenge in her first job. A lack of mentoring led her to seek another position after six months. “I didn’t have that mentor when I was in my first job. I was just told ‘go clean the tables’ and that kind of thing. I’m thankful that I have a mentor now…finding someone that helps you, rather than figuring it out yourself, is beneficial.”

While it is easy to assume that a graduate assistant position would be one in which the participants would receive more support than a full time athletic training position, this was not always the case in our participant group. While some of our graduate assistant athletic trainer participants developed professional skills under the supervision of a mentor, this did not always prove true. Several participants were graduate assistants. Some participated in formal mentoring as a part of their assistantships, others did not. Working as a graduate assistant was not a guarantee that one would have appropriate mentoring.

Additionally participating in mentoring, did not guarantee a positive experience. Several of our participants noted that they were assigned mentors, but had adversarial relationships with these advisors. If personality conflicts existed, or mentors were neither accessible, nor approachable, the benefits of this relationship decreased.

Jan served as a graduate assistant, but noted her position was a struggle due to poor mentoring…

We had a group orientation (of graduate assistants) but then I was shipped to a satellite room. At first my mentor seemed alright, but she was in the main facility and I was alone. We didn’t talk much. I had to figure things out on my own. I got in trouble because I didn’t do things the head athletic trainer wanted, but I was never taught what he wanted us to do. It was miserable. If my mentor had taken the time to work with me, it would have been better.

Jan’s perception was that improved mentoring would have led to success. Her belief in positive mentoring was offset by the challenges she experienced with lack of mentor availability. Simply having a mentor does not guarantee benefits, the mentoring may be deficient. For mentoring to be worthwhile, it must be meaningful to participants.

Importance of Comradery with Coworkers

Another theme was the importance of developing comradery with coworkers. This held true for both athletic trainers that worked in settings where they were part of an inter-professional sports medicine team and for athletic trainers that were (more commonly) the lone provider at their workplace. Participants expressed a belief that an attitude of being part of a team led to better workplace atmospheres. Several participants reflected this opinion. Deana, for example, noted “getting to know everyone kind of helped…I knew they all wanted me to succeed.”

Even participants that were the sole healthcare provider at their workplace indicated the importance of developing comradery with coworkers. Coaches, administrators, and other staff members were all cited as sources of support for these early career athletic trainers. It was apparent that good relationships with organizational stakeholders increased/improved communication. When Gina was hired as a secondary school athletic trainer, the football coach helped her adjust. “He really guided me through the fall season. Every time I had a question he answered it. He knew where equipment was stored; he understood the culture of the department…he would come to me each morning and say ‘Do you have any questions? How’s it going today?’ He was great and made it easier.”

Pat, however, had a negative experience in this capacity at a high school. As the first athletic trainer ever hired by the school, she believed that much of the negativity grew from poor relationships with coaches. She said…

No one really knew who I was or what I did. The athletes were not used to having an athletic trainer so they didn’t really know who I was. The coaches weren’t used to it either so they really didn’t know how to handle it. It was just not a good scenario… the coaches kept information like physical forms and I couldn’t get copies of those. I didn’t know who had a history of concussion. I didn’t know who had asthma and needed an inhaler…I didn’t know the history of anyone’s injury, so it was frustrating to be thrown into the situation where it made me feel unprepared.

C. Importance of Access to Documentation

Another key point that emerged was the importance of access to documents like policies and procedures manuals or employee handbooks. Participants that had access to such materials found it beneficial. Those without felt it would have helped them adjust in more satisfactorily manner. Rachel noted that a part of her orientation was to go over policies and procedures with the athletic director. “We went over everything, emergency action plans, everything. We even printed out EAPs (Emergency Action Plans) and made some changes.” Accessing the materials helped her understand expectations. She felt her input was appreciated. “It was phenomenal…there were constant questions, and having the policies and procedures made it an easier transition.”

Sam noted that there was no documentation at his first work place. While it was challenging, it provided the opportunity to invent his own way of doing things. “I had to create one (policies and procedures manual)…I kind of had free reign to set up things as I saw fit…it was a struggle, but afterwards I felt confident.” Sam’s attitude helped him overcome the negative situation and turn it into an opportunity to become comfortable. Terry found that access to a policies and procedures manual was an important contributor to the satisfaction she felt…

“We’re given it the first day of orientation and it has all the steps listed in it…we update it every year at a departmental retreat. We’ll go over certain changes to the Policies and Procedures Manual but everyone has access to it. It’s a 400 page book…but it is well worth the time spent reviewing it, because you don’t want to be thrown to the wolves.”

Participants noted value in accessing written information when other means of clarification were not available.


Previous research on the professional socialization of athletic trainers has been limited to research focusing on groups such as athletic trainers working in secondary schools [5,10], undergraduate athletic training majors [11,12], or female athletic trainers [13]. Few studies have investigated the perceptions of new professionals about the role their education played in the beginning of their careers. It was anticipated that we would learn about the transitional process of becoming fully independent. The results, however, brought to light several concepts that not only informed the investigators about the transition process but also indicated ways that education programs and employers could make entrance into the workforce more satisfying for novice athletic trainers. The concepts of mentoring, comradery, and documentation were identified as important.

Mentoring was deemed important in the development of athletic trainers [4,5,8,11,13]. Healthcare professionals benefit from mentoring, including nurses [14], physicians [15], pharmacists [16], and physical therapists [17]. Benefits of mentoring include improved learning of job functions, enhanced organizational advancement opportunities, and an expanded sense of competence [18]. The athletic trainers in this study focused on benefits they received from the process and avoided mistakes their mentors made. Our participants that had mentors found work more enjoyable. The participants that did not were frustrated and sought to exit their situations.

One area of consideration that is important is the differentiation of participants that served as graduate assistants versus those that entered the work force in another capacity. One traditional aspect of a graduate assistantship is mentoring to help guide the newly certified athletic trainer through their professional and/or academic responsibilities. That said, not all graduate assistantships are equal. While many students in this role receive thorough, competent mentoring, some participants in this study indicated disappointment with their mentoring. For mentoring to be beneficial, mentors need to be accessible, approachable, and provide consistent support.

Participants noted the value of developing positive relationships with their coworkers. The ‘team’ mentality is strong in athletics, and is likely to be valued by athletic trainers. While many participants were the lone health care provider at their worksites, the mentality of depending on no one was not strong among our participants. It was hypothesized that team  identity and seeking out help from coworkers would be important to our participants as ways to find emotional support in the workplace. This was the case; participants indicated that support from peers/coworkers helped manage frustration.

The process of developing comradery in healthcare fields has been previously considered in nursing. It was found that engaging with peers and satisfying a need to belong to a group were motivators to early career nurses [1]. The ‘silo effect’ of working alone has been found to lead to higher rates of attrition and decreased productivity in healthcare [19]. Collaboration and team-building not only improve communication and patient care, but can reduce anxiety of the new professional.

Investigations in athletic training have shown that positive socialization with faculty, preceptors, and peers leads to improved retention and satisfaction of athletic training students [7, 20-23]. It is conceivable that positive interactions with
co-workers could lead to improved workplace retention and satisfaction.

The final area of consensus was the importance of access to written documentation, either policies and procedures manuals or employee handbooks. Written documentation helps clarify expectations for employee behavior. For athletic trainers that are new to the workforce, this clarification is welcome. Such documentation provides newly certified athletic trainers an understanding of what constitutes appropriate professional behavior. This is particularly useful for those that do not have direct access to a supervisor to answer questions. There are times when immediate information is needed and coworkers with institutional knowledge might not be available. Looking up answers is an appreciated alternative.

The field of pharmacy provides an interesting point regarding documentation. The American Society of Health-System Pharmacists (ASHP) has accreditation standards that list a first year post-graduate residency requirement that programs list evaluation criteria. This standard is satisfied by provision of the information (along with standard operating procedures and a residency preceptor guide) in a program handbook [24]. Within athletic training, there is a more limited amount of research considering the importance of such documentation. Anecdotally it seems beneficial, and one could see how athletic trainers would find it beneficial to have this support.

This study indicated several areas that athletic training programs and employers might address to facilitate the process of role transition. Programs that teach students about mentoring and present tools that can be used to identify/approach prospective mentors will be beneficial, particularly to those that are hired by organizations that do not offer formal mentoring. By helping new athletic trainers identify mentoring resources, the transition is facilitated and improves professional satisfaction and retention.

Education program personnel can also develop the ‘team-first’ mentality and discourage the ‘silo effect’ in students. Utilizing
collaborative assignments and encouraging students to work with others will help them develop skills and abilities that can be applied in the workplace. By going into the workplace with the mentality that it’s better to work with others than to work on your own, improved productivity and satisfaction may occur. This concept takes on significance with the development of inter-professional competencies within education programs. As the field of athletic training transitions to entry-level master’s professional degrees, the emphasis on inter-professional collaboration should help graduates foster relationships with other healthcare providers. When novice certified athletic trainers enter the workforce, they will have a skill set to seek out productive relationships with coworkers. Finally, worksites can emphasize the importance of written documentation (such as employee handbooks or policies and procedures manuals). These references give new athletic  trainers means to seek out answers to questions when supervisors are not available. Education programs and worksites that address these points can improve the transition and contribute to higher levels of professional satisfaction for their graduates.

Participants in this project were limited to graduates of athletic training programs in the Eastern United States. Future research that considers graduates of programs in other parts of the country might produce different findings. The findings  may be less applicable to education programs or worksites that are already addressing this content. Future research that looks at specific types of education programs (public vs private universities) or employers (different work settings) might also generate different results.

Further information could have been collected from participants. Additional information, like participant’s age or additional credentials/education might better inform the results of this research. Older adults (older than typical college aged) might have a different perspective and those athletic trainers that enter the field after training and experience in other professions may have different early-career needs than the traditional early twenties athletic training program graduate entering the field.


The field of athletic training puts a unique set of demands on the new professional. There is very little margin for error when dealing with the health and safety of athletic patients with potentially catastrophic injuries, and newly certified athletic trainers are expected to act professionally and make no mistakes at the beginning of their career. By studying a group of early career athletic trainers, much can be learned about the support they wish had been available to them. The purpose of this study was to examine the opinions and perceptions of early career athletic trainers about their first year of post-certification work experience.

Three themes emerged. Novice certified athletic trainers that we interviewed indicated that mentoring, developing comradery with co-workers, and accessing written documentation were all ways to improve their professional socialization and satisfaction within the workplace. This holds implications for educational programs and employers. Those programs that
can help early career athletic trainers develop the skills to seek out mentoring, comradery, and written documentation will lead to increased workplace productivity and reduced attrition. This, in turn, can lead to improved job performance and improved outcomes in patient care.


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Cite this article: Christopher J Nightingale . Transition from Education to the Workplace: A Grounded Theory Investigation of Early Career Athletic Trainers.
J J Sport Med. 2016, 3(3): 023.

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