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Transition to Practice - Challenges – Role Ambiguity

Stacy Walker, PhD, ATC

Ashley Thrasher, EdD, LAT, ATC, CSCS

“How do I structure my hours?  I didn’t know quite the water situation; who does the water?  I didn’t know how to order supplies, like where they get them from, putting together a supply list. How long I need to give them before I run out of tape?  Do I have to give you 3 months in advance?  A week in advance?  That kind of thing.  So it’s a lot of whatever I ran into.  And of course, like when someone gets hurt, doctor-wise what do I do?”

These thoughts and challenges are common amongst newly certified Athletic Trainers. Despite their academic preparation and orientation, there commonly remains a great deal of ambiguity in their new role.  For the next installment of this series, we are exploring the next challenge newly certified Athletic Trainers experience as they make the transition from a student to a certified, independent clinician.

This role ambiguity stems from their uncertainty in their role as an Athletic Trainer due to a lack of clear responsibilities or expectations from employers and/or mentors.  This ambiguity is not necessarily related to the patient care aspect of their role, but often involves confusion related to administrative procedures when making the transition.

This uncertainty regarding many aspects of their role causes stress among new clinicians.  Examples of these uncertainties and stressors include:

- Lack of formal and informal orientation into role

- Not knowing how to document injuries at their specific institution (e.g., Are the records paper or electronic? Are there standardized forms?)

- Not knowing the specific protocol on referring athletes and to whom to refer athletes

- Not knowing the ordering and/or budgeting process at their setting and when to order medical supplie

- Having limited or no access (i.e., locked in principal’s or nurse’s office) to patient health records (e.g., pre-participation physical exam, health history

- Not understanding procedures or lack of protocols (e.g., concussion, emergency action plan)

- Not knowing if they are allowed to use their cell phones in the clinical setting

- Not having a supervisor or mentor

- Not having clear expectations from their supervisor

“It’s been weird because I’m used to what is expected of you at the college level.  Now with the current situation, at the high school and at the clinic, they really have no idea what to expect of me.  Which is a little weird because I’m used to meeting expectations and surpassing them, but when you don’t really have set expectations that you’re knowledgeable of, it makes it a lot harder to do that.”

This quote speaks to the uncertainty experienced by a new clinician when they are unsure of what others expect of them.

Role ambiguity frequently causes stress.  This unnecessary stress can lead to many negative outcomes, such as burnout, decreased quality of patient care, decreased patient satisfaction, feelings of inadequacy and depression (Chang, 2003; Acker 2004).  Job stress can lead to decreased job satisfaction and increased intent to leave.  One newly certified Athletic Trainer shared that she had considered leaving the profession because of stress involved with the transition.

“The first few weeks of my job were very stressful, trying to adapt to all my new responsibilities.  I wasn''t sure if I was cut out for the profession.”

These negative outcomes caused by role ambiguity not only hurt individual Athletic Trainers, but are also detrimental the patients, employers and athletic training as a profession.

Role ambiguity can harm patients because new Athletic Trainers are often so overwhelmed with procedural questions that they focus their energy on adjusting to their roles.  As new Athletic Trainers transitioned, many questions they had were related to role expectations, policies and procedures and administrative items.  When the same Athletic Trainers were interviewed 6 months later, most of their questions were related to patient care.  Once they understood their role, they were able to focus more on their patients.

There are many reasons why young Athletic Trainers decide to leave the profession, including burnout, role strain and role overload (Kahanov, 2013).  For new nurses, role ambiguity is one of the major sources of job stress (Lu, 2005; Chang, 2003), which leads to an increased intent to leave.  Attrition can be costly to employers and reflects poorly on the profession of athletic training.New Athletic Trainers need support to help manage role ambiguity.  There have been many transition to practice programs that have been implemented in nursing to help with the transition and decrease role ambiguity.  Some features of these programs include orientations, a designated resource person and peer support (Rush et al; Whitehead).  We will be further discussing some ways to provide support and help with role ambiguity later in this series.

References

  1. 1.       Chang E, Hancock K. Role stress and ambiguity in new nursing graduates in Australia. Nurs Health Sci. 2003;5(2):155-163.
  2. 2.       Acker GM. The effect of organizational conditions (role conflict, role ambiguity, opportunities for professional development, and social support) on job satisfaction and intention to leave among social workers in mental health care. Comm Mental Health J. 2004;40(1):65-73.
  3. 3.       Lu H, While AE, Barriball KL. Job satisfaction among nurses: A literature review. Int J Nurs Stud. 42(2):211-227.
  4. 4.       Kahanov L, Eberman LE, Juzesyn L. Factors that contribute to failed retention in former athletic trainers. Internet J of Allied Health Sci Practice. 2013;11(4):1-7.
  5. 5.       Rush KL, Adamack M, Gordon J, Lilly M, Janke R. Best practices of formal new graduate nurse transition programs: An integrative review. Int J Nurs Stud. 2013;50(3):345-356.
  6. 6.       Whitehead B, Owen P, Holmes D, Beddingham E, Simmons M, Henshaw L, Barton M, Walker C. Supporting newly qualified nurses in the UK: A systematic literature review. Nurs Educ Today. 2013;33(4):370-377