On a medical-surgical unit, a patient who is hostile and belligerent has been difficult for staff. Which approach best supports his care?

• A. Rotate the assignment schedule so that no one has to care for him more than once or twice a week.
• B. Pair a float nurse and a nursing student and assign the patient to that team because they will have a fresh perspective toward the patient.
• C. Identify two or three experienced nurses as primary caregivers and develop a plan that includes psychosocial interventions.
• D. Assign yourself as primary caregiver so that you can role-model how patients should be treated.

Answer: (C)

The key idea is that hostile or belligerent behavior is best managed with a consistent, experienced team that can implement a planned, psychosocial approach. Having two or three experienced nurses serve as primary caregivers creates continuity of care, so they can recognize early signs of escalation, maintain a stable therapeutic relationship, and apply a coordinated strategy across shifts. With an established plan, they can use psychosocial interventions to address underlying needs and reduce agitation. This involves calm, respectful communication; validating the patient’s feelings; exploring possible causes like pain, fear, or confusion; setting clear boundaries and expectations; and bringing in additional support services if needed. The stability of familiar staff and a thoughtful psychosocial plan together improve safety and the likelihood of a positive response from the patient.

Rotating assignments or pairing a float nurse with a student doesn’t build the trust or consistent approach needed for de-escalation. Expecting one nurse to role-model for the whole team can overburden that nurse and still fail to provide a team-based, comprehensive plan.