[2] In Ken Kesey's novel, Ratched "the Big Nurse" is described by Chief Bromden according to him: "She had a face that is smooth, calculated, and precision-made, like an expensive baby doll, skin like flesh-colored enamel which is a blend of white and cream, with baby-blue eyes, and a small nose with pink little nostrils.

The only features that does not match Ratched's appearance are her lips and fingernails that are both an "odd" or "funny" red-orange, like the tip of a soldering iron, a color that looks so hot or so cold that if she touches someone with it, no one could tell which."

Ratched wears a white, heavily starched, nurse's uniform that she uses to conceal her top-heavy bosom as she is ashamed and embittered of them.

She wears her hair in a tight bun and high heels where she walks stiffly everywhere she goes, and sometimes carries a woven wicker bag that contains pills, needles, wire, and forceps.

McMurphy helps organize an unauthorized party late one evening, and they invite two prostitute friends, Sandra and Candy, into the asylum.

However, McMurphy's attack leaves Ratched weakened and bruised, and she loses her absolute control over the ward because the patients no longer fear her.

[4] The character was famously portrayed by Louise Fletcher in the film adaptation, whose performance earned her the Academy Award for Best Actress.

Fletcher, who, up to that point, had only had a brief television career in the 1950s and early 1960s and had only appeared in two films (one uncredited), was cast after Anne Bancroft, Angela Lansbury, Geraldine Page, Colleen Dewhurst, and Ellen Burstyn turned down the role.