Team-based nursing, known as Kirwat, originated as a way for working clinicians to share knowledge and skills. The idea was that, while the individual practitioner would be able to provide a certain set of skills, the team could share information on how to maximize and achieve them.
The first iteration of this vision emerged after World War II, when economics drove hospitals and medical schools to become coordinated, said Dr. Stephen Mastrodonato, president of a nonprofit called TeamNurse. The model proved effective in community hospitals, but in the 1960s and ’70s, hospitals that relied primarily on beds — where the nursing staff was located directly on site — and not nursing schools emerged. Combined with the loss of human resources to medical schools and the training available at community facilities, these new methods began to impose on nurses.
One group of nurses soon learned the differences between team-based and individual-based nursing and felt it was time to “recycle” the old model back into the practices of their predecessors. Led by the president of the American Nurses Association, Dr. Millicent Jones, the group proposed establishing a single professional division instead of separate teams within a hospital. The strategy was not a formalized choice, but it reflected the philosophy that the division would foster the nurses’ sharing of knowledge and the efficient use of services. Team-based nursing developed as a “natural way” for nurses to share knowledge in an efficient manner.
The failure of the proposal to be adopted, however, wasn’t because it did not embody the original vision. It was rejected because the changes made it more than just a shift in hierarchy. “In the short run, team-based nursing was met with resistance because it didn’t represent individual responsibility and individual care, but focused on the creation of an organization and required greater authority for nurses,” said Karen Mazek, a community nurse who began to push for change in the 1990s.