A former army nurse, Nurse Ratched represents the oppressive mechanization, dehumanization, and emasculation of modern society—in Bromden's words, the Combine. Her nickname is “Big Nurse,” which sounds like Big Brother, the name used in George Orwell's novel 1984 to refer to an oppressive and all-knowing authority. Bromden describes Ratched as being like a machine, and her behavior fits this description: even her name is reminiscent of a mechanical tool, sounding like both “ratchet” and “wretched.” She enters the novel, and the ward, “with a gust of cold.” Ratched has complete control over every aspect of the ward, as well as almost complete control over her own emotions. In the first few pages we see her show her “hideous self” to Bromden and the aides, only to regain her doll-like composure before any of the patients catch a glimpse. Her ability to present a false self suggests that the mechanistic and oppressive forces in society gain ascendance through the dishonesty of the powerful. Without being aware of the oppression, the quiet and docile slowly become weakened and gradually are subsumed.

Nurse Ratched does possess a nonmechanical and undeniably human feature in her large bosom, which she conceals as best she can beneath a heavily starched uniform. Her large breasts both exude sexuality and emphasize her role as a twisted mother figure for the ward. She is able to act like “an angel of mercy” while at the same time shaming the patients into submission; she knows their weak spots and exactly where to peck. The patients try to please her during the Group Meetings by airing their dirtiest, darkest secrets, and then they feel deeply ashamed for how she made them act, even though they have done nothing. She maintains her power by the strategic use of shame and guilt, as well as by a determination to “divide and conquer” her patients.

McMurphy manages to ruffle Ratched because he plays her game: he picks up on her weak spots right away. He uses his overt sexuality to throw her off her machinelike track, and he is not taken in by her thin facade of compassion or her falsely therapeutic tactics. When McMurphy rips her shirt open at the end of the novel, he symbolically exposes her hypocrisy and deceit, and she is never able to regain power.