Q&A with April Hoy

January 29, 2015
Azusa Pacific University
For most athletic trainers, treating injured athletes on the field of play and rehabbing them in the athletic training room are only parts of the job. Much of their work continues behind the scenes as they aspire to grow their department and advance the profession. Few athletic trainers have done this as tirelessly as April Hoy, MS, ATC, CSCS, Head Athletic Trainer at Azusa Pacific University, which is in the midst of its first full year of NCAA Division II membership after a three-year transition from the NAIA.

Hoy graduated from Azusa Pacific in 1995 and spent time at Mt. San Antonio College and the California Institute of Technology before returning to work at her alma mater in 1999. Since then, she's impacted the school in countless ways. Not only has Hoy doubled the size of the athletic training staff and created the department's policy and procedure manual, but she's also helped redesign the school's athletic training rooms and currently serves as the university's Deputy Title IX Coordinator. A two-sport athlete at Azusa Pacific as an undergrad, Hoy was elected into its Athletics Hall of Fame in 2009.

Her devotion to the profession extends to the national level. In addition to serving as the NAIA Athletic Trainers Association President from 2004 to 2007 and the District and Regional Chair for the NATA College/University Athletic Trainers' Committee from 2011 to 2014, she's helped author NAIA guidelines for eating disorders, the value model of a college athletic trainer, and legal issues in athletics. Here, Hoy discusses how she grew her department, the keys to creating an effective policy manual, and how success on the playing field can impact an athletic trainer's job.

How did you go about expanding your athletic training staff at Azusa Pacific?
It took a lot of determination and persistence. When I first got here, I was one of two full-time athletic trainers, and it was challenging to keep all the athletes healthy. But I understood that money doesn't grow on trees, so I couldn't just ask for more staff without completely justifying that request.

The first step in trying to get more athletic trainers hired was documenting all of the hours my colleague and I worked and detailing all the tasks we performed. Then, by referring my administrators to the NATA's Recommendations and Guidelines for Appropriate Medical Coverage of Intercollegiate Athletics, I was able to show them what kind of coverage we should be providing. By doing this, the administration could see that we needed more than two athletic trainers to service all of our athletes.

One thing that helped was the timing of my proposals. When the athletic department decided to add new sports, I went to the administration with my work logs and said, "We're stretched to the max as it is. If we add these sports, who's going to cover them?" That's when it became a question of risk management for the school, rather than simply a discussion of money. I ended up having to write a lot of proposals asking for more help, but now we're staffed with four full-time athletic trainers and four graduate assistant athletic trainers.

What are the keys to mentoring graduate assistants?
It starts with having a clear understanding of a mentor's role. Once you understand what's expected of you in mentoring, you'll be more effective at it.

Prior to the start of the 2013 fall semester, I brought my full-time staff together to list the traits of a good mentor. Some of the things we discussed were integrating the grad assistants into the Azusa Pacific way of doing things and being receptive if they came to us with questions about treating an injury. But mentoring also should include checking in with them to see how they are adjusting to graduate school, and, in some cases, being away from home for the first time.

What was it like to help redesign Azusa Pacific's athletic training facilities?
It was a lot like doing home improvements. Most architects and construction workers aren't familiar with how a sports medicine facility should be set up, so it was critical for me to get involved early on and constantly stay on top of things.

For example, there can't be any trip hazards in the "wet area" of an athletic training room because there is always water on the floor from the whirlpools and ice machines. So I made sure the contractors built that area of the room with a grated trough for the water to flow into for greater safety. In the end, everything worked out, and I was happy with the environment I helped create for the athletes.

As your school's Deputy Title IX Coordinator, how do you think athletic trainers can play a role in Title IX compliance?
I don't think a lot of athletic trainers realize that they're in a very unique position with regard to the law. We see behind the scenes of an athletic department and often notice overlooked inequalities, like if one sport gives each player their own hotel room on road trips, while another makes athletes double or triple up. And because we're not part of any team's coaching staff, we can be a neutral voice in reporting Title IX concerns.

How did you create the policy and procedure manual Azusa Pacific uses?
I had created one when I was at Cal Tech because I frequently found myself calling the former head athletic trainer with questions about department protocols, and I didn't want anyone else to have to repeat those struggles. When I came to Azusa Pacific, I was concerned about going through the same thing again because the only policy paperwork I was given was a sheet that covered first aid guidelines. So during my first weekend on the job, I looked at what other schools were doing and put together a 20-page packet covering important topics such as treating an athlete's eating disorder and administrative responsibilities.

My staff and I have continually added to it over the years, and now it's 100 pages long. It addresses everything from emergency procedures and day-to-day operations to our expectations for professionalism and ethics.

What makes a manual successful?
It's critical that your policies are detailed enough that they provide clear guidance for your staff without being so specific that they restrict your treatment options. For example, when we were developing procedures for stabilizing an injured player's head and neck, our policy originally said we needed to use one specific technique. We realized there might be a similar situation that was best served by a different technique, so we removed the language that dictated it as the only option for treatment.

How does it feel to work at an institution where you're also a member of its Athletics Hall of Fame?
It's very humbling to think that my name is on the wall with so many great athletes. But I think it also gives me some "street cred" with the current athletes, especially those who play soccer and softball like I did. They know that I've been through the same challenges of being a student-athlete, and that I've overcome them successfully.

You've worked with teams that have had varying levels of athletic success. How does winning and losing affect an athletic trainer's job?
When your teams are winning, obviously morale is good, but sometimes it can lead you to put too much pressure on yourself to return an injured athlete quickly. In those situations, it's critical to remember that coaches understand athletes will get hurt and focus your energy on getting the player healthy.

When your teams are struggling, the athletic training room can become a place for athletes to air their frustrations without their coaches around. I know it's tempting to be the "cool" person who lets them do that, but I believe you need to nip that behavior in the bud by setting boundaries for what's acceptable in the athletic training room. I tell the players that my staff and I won't tolerate them bad-mouthing coaches or complaining about playing time.

What were the highlights from your time as a member of the NATA College/University Athletic Trainers' Committee?
It really kept me on the cutting edge of the profession. One of the biggest things we worked on was developing the value model of a college athletic trainer, a document and presentation that outlines the importance of the services they provide. Our profession is misunderstood by a lot of people, including some athletic administrators, so the value model was a way for us to help them understand all the things we do.

In addition, at the 2013 NATA meeting, we spoke about how the licensing of athletic trainers varies from state to state and that potential ramifications could arise should an athletic trainer travel over state lines and do something that violates another state's practice act. As a result, there's now a proposed bill in the U.S. House of Representatives and Senate that would allow athletic trainers licensed in one state to perform those same duties in another. There's a lot of support for it throughout the medical community, and it was great to help drive its beginning.

How do you maintain a work-life balance?
I wasn't good at it early in my career because I was entirely focused on work. A few years ago, I got more involved with my church, and that helped me realize that I needed to take more time for me. Now that I recently got married, this has become even more important. One thing that helps is being open and understanding with my athletic training staff about their need to lead a balanced life. By encouraging them to spend time with their families, I don't feel hypocritical if I want to spend time with my spouse.
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