The nurse-patient relationship is one that is built
on mutual trust and respect that fosters hope and assists in a harmonious
healing process. A nurse has the professional duty to the patient to provide
physical, emotional, and spiritual care to avoid injury. Any negligence in
rendering care to the patient is direct disregard and may result in
malpractice. This is the crux of the problem with Nurse Ratched. In One Flew
over the Cuckoo’s Nest, Nurse Ratched is guilty of malpractice as she forced
marginalized people in society to conform to societal norms through the cruel
medical treatments she practiced, mental anguish she inflicted on the patients,
as well as the undue authority she exercised in the hospital.

In One Flew over the Cuckoo’s Nest, Nurse Ratched is the antagonist and her use of
cruel medical treatments is the main argument for malpractice. She used daily
doses of medication, electroshock therapy, and a lobotomy procedure to “treat”
the patients in the ward. “Put your troubled mind at ease, my friend. In all
likelihood, you needn’t concern yourself with EST. It’s almost out of vogue and
only used in the extreme cases nothing else seems to reach, like lobotomy”
(Kesey 148). Nurse Ratched’s treatments were more harmful than helpful. The
medication she used was over-prescribed and unnecessary. It just sedated the
patients to keep them calm while not actually helping them to cure or to
rehabilitate. Nurse Ratched used the medication in order to make the patients
adhere to society’s behavioral norms. In addition to medication, Nurse Ratched
used electroshock therapy that had no positive effect on the patients. While it
caused injury to the patients, the real intent was to force them to comply with
Nurse Ratched’s strict rules. By doing so, Nurse Ratched was stealing her
patients’ freedom and their way of expression. This is in direct contrast to
what a nurse is supposed to do. Nurses are called upon to care for their
patients and their needs, not hurt them. Nurse Ratched also had no qualms about
recommending lobotomy procedure for her patients. By doing so, she was
responsible for turning them from an acute to a chronic patient. Nurse Ratched
prescribed lobotomy for McMurphy simply as revenge for attacking her even
though she knew that he was not really crazy and the doctors were even contemplating
on sending him back to Paddington Work Farm to complete the remainder of his
six-month work prison sentence. This was a totally unnecessary procedure which
in itself is a reason for malpractice. Another reason to consider this as
malpractice is because Nurse Ratched did not get consent from McMurphy’s family
before deciding on giving him this cruel and medically risky treatment.

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“Patients were slowed up in thinking and acting, they were dull, at times completely
lacking in emotional expression or display and showed a striking reduction in
interest and driving energy. Others receiving the same operation were
uninhibited and euphoric and they were somewhat restless with a purposeless
type of activity” (“Effects of Lobotomy”). This research at the time shows that
the treatments that were employed by Nurse Ratched had detrimental consequences
to her patients. Nurse Ratched used a lobotomy procedure because she thought
that the patients are outliers in society, and were beyond repair.

Nurse Ratched was the main source of mental anguish
for the patients in the ward. She caused more pain than relief for the
patients. “Mrs. Bibbit’s always been so proud of your discretion. I know she
has. This is going to disturb her terribly. You know how she is when she gets
disturbed, Billy; you know how ill the poor woman can become. She’s very
sensitive. Especially concerning her son. She always spoke so proudly of you”
(Kesey 242). Nurse Ratched threatened Billy Bibbit to ensure that he does not
have a relationship with any woman even though Billy pleaded with her not to
tell his mom about his episode with a prostitute. This caused lasting emotional
damage to Billy that eventually led to his suicide. Nurse Ratched was trying to
suppress his sexual liberation and exploration as it did not fit with society’s
traditions. This is unquestionably malpractice by Nurse Ratched. Her role as a
nurse in a hospital is to foster an environment where her patients feel safe
and protected emotionally. This was not the case with Billy who felt threatened
by her. He could not take the threats from Nurse Ratched anymore and believed
that the only solution was death. Nurse Ratched could be described as the main
culprit who drove Billy to suicide.

The group therapy session meetings conceived by Nurse
Ratched were unhealthy by nature and caused mental anguish for the patients.

From each patient’s medical records, she learned personal and confidential
information about them. Nurse Ratched used this information and manipulated the
men in the ward to disclose their secrets to the group through probing
questions during the group therapy. 
“Their mouths opened in unison. Her sweeping eyes stopped on the first
man along the wall. His mouth worked. I robbed a cash register in a service
station. She moved to the next man. I tried to take my little sister to bed
” (Kesey 39). Nurse Ratched pinned all the men against each other, and in
doing this, all the men were at odds with each other. This lead to the
uncovering of very personal and confidential information that was used by the
men in the ward to humiliate each other. Nurse Ratched was trying to use
humiliation as a way to get the patients back on “track” with society’s rules. This
is evidence for Nurse Ratched’s malpractice, as it was a breach of the
nurse-patient confidentiality. “The objective of this confidential relationship
is to make patients feel comfortable enough providing any and all relevant
information. This helps the doctor to make a correct diagnosis, and ultimately
to provide the patient with the best possible medical care” (“Breaches of
Doctor-Patient Confidentiality”). Nurse
Ratched hurt the patients’ medical care as they were not emotionally cared for
by exposing secrets and humiliating them publically which is a cause for legal

Nurse Ratched’s unchecked authority over the hospital
led to mishandling of the patients in the ward. She controlled every movement
and every person’s actions and thoughts. She made the doctors so miserable when
they did not follow her instructions, that they begged to be transferred out of
the hospital. “I’m disappointed in you. Even if one hadn’t read his history all
one should need to do is pay attention to his behavior on the ward to realize
how absurd the suggestion is. This man is not only very very sick, but I
believe he is definitely a Potential Assaultive” (Kesey 53). This quote from
the book illustrated how Nurse Ratched controlled her ward. She manipulated
people into siding with her regardless of whether or not it was the right
decision. This was malpractice by Nurse Ratched because she did not allow the
doctors, who were trained to diagnose patients, to do their job properly.

Instead, she manipulated the doctors to diagnose the patients incorrectly in
order to benefit her interests rather than those of the patients.

Nurse Ratched’s selection of the orderlies further
exemplifies her misuse of authority over the hospital which contributed to
malpractice. “They are in contact on a high-voltage wavelength of hate, and the
black boys are out there performing her bidding before she even thinks it” (Kesey
24). Nurse Ratched favored orderlies that conformed to her strict rules than
those that were actually trained for the job. Nurse Ratched retained orderlies
based on how much they hated and mistreated the patients. The more they hated,
the better suited they were for the ward. She wanted them to hate without her
having to tell them. This can be construed as malpractice because Nurse Ratched
created an environment where the patients were physically threatened by the
orderlies. Another aspect to consider as malpractice was that Nurse Ratched was
not providing orderlies to the patients who were even qualified for the job.

She was using the orderlies to enforce societal norms in the hospital which
resulted in malpractice.

Nurse Ratched is guilty of malpractice due to her
cruel medical treatments, the mental agony she inflicted on the patients, and
the uncontrolled power she ran the hospital with. People who are less fortunate
or marginalized in society need to be protected from harsh societal punishments
as a result of their different ideologies and sometimes their mental
limitations. It is important to recognize the motives, signs, and symptoms of
malpractice to make sure that justice is served for all those that are being
ill-treated and victimized.