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If Mr. McMurphy doesn't want to take his medication orally, I'm sure we can arrange that he can have it some other way. But I don't think that he would like it.
~ Nurse Ratched threatening McMurphy.

Nurse Mildred Ratched is the main antagonist of the late Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest and its 1975 film adaptation of the same name, as well as the eponymous protagonist villain of the 2020 TV series Ratched. She is the cold, sadistic head nurse of the Salem Oregon State Hospital, where she dominates her patients into submission with iron discipline and cruel punishments. She is also the archnemesis of Randle P. McMurphy, a free-spirited patient who refuses to bend to her will.

She is often considered one of the greatest female villains in movie history, rivalling others popular characters such as Wicked Witch of the West in The Wizard of Oz, Alex Forrest in Fatal Attraction, Phyllis Dietrichson in Double Indemnity, and Mrs. Danvers in Rebecca. Ratched was named the fifth greatest villain in movie history by The American Film Institute, and she is often considered among the most hated characters in movie history.

In the film, she was portrayed by Louise Fletcher, who also portrayed Olivia Foxworth in the 1987 film adaptation of Flowers in the Attic and Kai Winn Adami in Star Trek: Deep Space Nine. In the Netflix series Ratched, a prequel to One Flew Over the Cuckoo's Nest, she was portrayed by Sarah Paulson, who also portrayed Mary Epps in 12 Years a Slave, Dr. Zara in Abominable, Dr. Ellie Staple in Glass, Anne Gillette in Law & Order: Special Victims Unit, Ally Mayfair-RichardsSally McKenna, and Wilhelmina Venable in American Horror Story, and Diane Sherman in Run. In Once Upon a Time, she was played by Ingrid Torrance.


Being head nurse, Ratched has control over medication, therapy, hygiene, recreation, among others. Her superiors esteem her for being one of the best nurses in the facility. Ratched is a firm believer in keeping people orderly, and will revoke any privileges they might have if they act out of line in any way. She keeps the patients in line by using their mental weaknesses, and encourages other patient to act is informants for her so that she can use sensitive information against a patient as she sees fit.

When a criminal named R.P. McMurphy arrives to the ward, he begins to disobey Ratched's schedule and tries his best to annoy and meddle her. As McMurphy's disorder persists, she uses increasingly harsh "therapies", incluiding electric shock treatment, as punishments for acting out.

McMurphy arranges a party for his fellow patients, complete with alcohol and prostitutes, as a way of saying goodbye since he plans on escaping the facility. The next morning, Nurse Ratched ejects these intruders and finds one patient, Billy Bibbit, sleeping with a prostitute. The depressed, submissive Billy finds confidence for the first time in his life and stands up to Nurse Ratched when she tries to sham him for having sex with a prostitute. Determined to put him back in line, Ratched threatens to tell Billy's mother, the only person he fears more than her, about the party. Distraught, Billy commits suicide. McMurphy, in a fit of rage, throttles Ratched, almost choking her to death.

Ratched survives, but McMurphy's assault has rendered unable to speak above a whisper. Desiring revenge, she orders McMurphy lobotomized, leading to his death when his friend and fellow patient "Chief" Bromden smothers him with a pillow to put him out of his misery. While she succeeds in getting rid of McMurphy, however, the other patients have learned from his example how to stand up for themselves, rendering her powerless over them.


Nurse Ratched is portrayed as a cruel, power-hungry sadist. She is a formalist who strongly believes that the best thing to do is to have patients conform to a schedule. Nothing will make Nurse Ratched stray from schedule and routine, even the death of a patient (which she does to prevent utter chaos amongst other patients). She has no tolerance for rule-breakers, especially people who are openly sexual. Ratched is very calm and uses her knowledge of other's weaknesses to make them submissive and obedient. She initially acts quiet and reassuring, but can turn stern when a disorderly patient persists. She dislikes every form of disorder, from rebellion to untidiness. She wears a black overcoat and a black barrette outside of work. In the book, she is perceived by a paranoid patient (Bromden) as unfeeling, manipulative, and working for an oppressive society ("The Combine").


  • Louise Fletcher has stated in recent years that she can no longer watch her performance as she feels the character's cruelty is "inhumane".
  • In Kesey's novel, Ratched is an allegorical character, symbolizing the dehumanizing effects of limitless authority on the individual.
  • Ethan Hawke has stated that he based his performance of Arthur Harrow from Moon Knight on Nurse Ratched, among some historical figures.