Cadence fills a gap within interprofessional practice. Filling that gap benefits clients, families, and professionals themselves.

The concept of “scope of practice” is commonly used by health professionals and health researchers, but it’s also helpful for thinking about Cadence’s mission and our approach to partnerships. In this article, we will address scope of practice and what “scope creep” can look like. Most importantly, you will learn of different strategies to prevent scope creep from occurring in your own workplace.

The professional landscape around end-of-life transitions

To plan for and cope with death, families and individuals interact with a range of professionals. 

• Funeral directors, embalmers, and cemetery workers manage body transfers, memorialization rituals, body dispositions, and sites for remembering and honoring the dead. 
• Estate lawyers advise executors about their legal obligations and rights concerning actions related to the will, disbursement of assets, probate, final tax returns, and more. They also help individuals with developing last wills and testaments, power of attorneys, and and other key estate planning documents.
• Financial advisors, family accountants, and insurance agents assist  individuals and families to identify financial goals, manage risk, select investment funds, and access accounts to ensure financial security at the ends of their life and for future generations.
• Grief counselors and psychologists help individuals to acknowledge loss, sense of it, and establish new connections to their loved ones after they pass.
• Executor advisors - like the ones working at Cadence - support executors with the practical, logistical steps that come after death. We identify which paperwork executors need to complete, provide the resources they need to submit it, and work with them to ensure the affairs of the deceased are closed. 

Between all these professionals, it’s not always clear who will (or can) take care of which tasks when a death occurs. Both families and professionals can find themselves in positions where they’re unsure where one professional’s “scope of practice” ends and where another’s begins. 

The concept of “scope of practice”

We most often see the term “scope of practice” discussed in relation to health professions, including nursing, medicine, pharmacy, physiotherapy, and occupational therapy. But it’s broad enough to use in relation to other professionals as well. Nurse researchers White and colleagues (2008) define a “scope of practice” as “the full range of roles, responsibilities and functions that [professionals] are educated, competent and authorized to perform” (p.45). More simply, scope of practice refers to the tasks performed by professionals as a part of their day-to-day work (White et al., 2007).

Why “scope of practice” matters

Social scientists have long understood that people seek a basic level of structure and boundaries when it comes to social life (consider the classic work of Arnold Van Gennep, Erving Goffman, or Talcott Parsons). In a world that is always in flux and uncertain, we use social roles, scripts, and boundaried expertise to provide a sense of predictability and security. Along these lines, a “scope of practice” is a formal tool that helps people navigate the social world and interact within it effectively.

What happens when scope of practice is unclear or broad?

• Lack of recognition. A weak grasp of one another’s work can also be interpreted as a lack of acknowledgment for its unique contributions and knowledge bases (White et al., 2007). 
• Unproductive competition. While competition within a given profession is understandable, a poor understanding of scope of practice can generate unwarranted competition between professionals or companies who might gain something by partnering (Baranek, 2005).
• Difficulties standardizing service across clients. Extending your scope of practice can also mean that service becomes poorly standardized across clients, where some clients receive all the bells and whistles and others do not.
• Organizational challenges. Managing workers with ambiguous or extended responsibilities can be challenging when trying to move a business through transitions, especially when it complicates information hand-offs, scaling up, salaries, or titles. 
• Burn-out. Ultimately, burn-out can become a threat if professionals carry a poorly defined scope of practice.
• Frustration. When roles are confused for one another and there’s little consensus around each one’s unique training or expertise, it can be frustrating - not just for workers, but also for clients trying to navigate complex processes (like end-of-life care and planning).

Why we try to exceed or extend our scope of practice

There are risks that come with an unclear or excessively broad scope of practice. And yet, many of the reasons professionals exceed their formal responsibilities are highly understandable. 

• Service. Often professionals who are not “staying in their lane” simply want to provide service that goes above-and-beyond. Extending their domain of expertise can feel like an opportunity to add value to their services.
• Responding to unmet needs. Some may also begin exploring new domains of work as a response to an unaddressed need. 
• Genuine curiosity might be part of the trigger that leads professionals to take on duties absent in their job description. 
• Working to their potential. In some scenarios, a professional’s scope of practice may be excessively narrow or limiting. To benefit clients and increase professional freedom, broadening one’s scope - or working in “full scope” - is warranted as a new professional standard (Tsuyuki & Davies, 2018)

Other times, the reasons may not be as altruistic.

• Some professionals might not want to admit they don’t know the answer to a question. Rather than admitting where their job stops and begins, they attempt to do or know it all, diluting their role in the process.
• Some professionals may also have difficulty saying “no.” You might call these the people-pleaser types: they feel that clients or families will be disappointed if they decline a request for help that transcends their duty. Instead of referring them elsewhere or offering starting points, they attempt to bridge the gap themselves.

How Cadence helps professionals determine the limits of work within their scope of practice

No single insurance agent, funeral director, grief counselor, lawyer, or financial advisor has all the answers when it comes to end of life paperwork. By the same token, Cadence doesn’t pretend to be in the business of transferring bodies, offering legal advice, providing therapy, or advising on important financial decisions. We believe in interprofessional collaboration as a means to smoothing individuals’ and families’ journeys toward death. Our aim is not to duplicate work or take over other professional’s core roles and responsibilities; we’re trying to address an unmet need in the landscape of death professionals. 

This gap is evident: in a survey we conducted in 2021, 40% of executors said no one (professional or otherwise) had helped them with ending subscriptions, applying for benefits, and/or sending notifications. Clearly, this suggests lawyers, financial advisors, insurance agents, and others can supplement their work and serve clients better by partnering with Cadence. 

As professionals, none of us can do it all, but we can take up the opportunity to educate clients and families about how our unique roles and scopes of practice collectively can support transitions at the end of life. 

If you’d like to learn more about how our work can complement the work you’re doing as a professional, book a demo with us today.