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Main antagonist of Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest

Nurse Ratched (full name Mildred Ratched in the movie, also known as "Big Nurse") is a fictional character and the main antagonist of One Flew Over the Cuckoo's Nest, first featured in Ken Kesey's 1962 novel as well as the 1975 film adaptation. A cold, heartless tyrant, Nurse Ratched has become the stereotype of the nurse as a battleaxe. She has also become a popular metaphor for the corrupting influence of institutional power and authority in bureaucracies such as the psychiatric treatment center in which the novel is set. Nurse Ratched is the head administrative nurse at the Salem State Hospital, a mental institution where she exercises near absolute power over the patients' access to medications, privileges, and basic necessities such as food and toiletries. She capriciously revokes these privileges whenever a patient displeases her. Her superiors turn a blind eye because she maintains order, keeping the patients from acting out, either through antipsychotic and anticonvulsant drugs or her own brand of psychotherapy, which consists mostly of humiliating patients into doing her bidding. Her tyrannical rule and her cruel personality stems from her time as an army nurse during World War II.

Author Kesey stated that he based Ratched on the head nurse of the psychiatric ward where he worked. He later ran into her at an aquarium, realizing "She was much smaller than I remembered, and a whole lot more human." The 1940s hairstyle was, according to Louise Fletcher, "a symbol that life had stopped for her (Ratched) a long time ago".

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." She is also most noted for carrying breasts that are described as either "massive" or "over sized". Ratched's uniform is a white, heavily starched, nurse attire 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. To everyone else, she is a dull looking middle aged woman and is mainly an intimidating nurse who comes off as a twisted maternal figure to her patients. Milos Forman's depiction of the character, who is played by Louise Fletcher, however, is based on the stage play performances of the character in Broadway, New York.

When Randle McMurphy arrives at the hospital, he flouts her rules with impunity and inspires other patients to follow. Her attempts to cow him into submission—at first with threats and mild punishments, then with shock therapy—are unsuccessful, serving only to fuel his defiance. McMurphy helps organize an unauthorized party late one evening, and they invite two prostitute friends, Sandra and Candy, into the asylum. After noticing fellow patient Billy Bibbitt has a crush on Candy, McMurphy encourages her to have sex with him. Ratched catches Billy and Candy in the act. Furious, she threatens to tell his mother. He begs her not to, blaming McMurphy and the other patients for orchestrating the event. Ratched sends him to wait in the ward doctor's office as the authorities are called. When Dr. Spivey finally arrives, he finds Billy has killed himself. When Ratched tells the inmates that "the best thing we can do is to go on with our daily routine", McMurphy attacks her in a fit of rage, nearly strangling her. Despite having McMurphy lobotomized in retribution, the attack leaves Ratched weakened and bruised, now unable to control the ward any longer because the patients no longer fear her.

A stage adaptation by Dale Wasserman made its Broadway debut in 1963 with Joan Tetzel as Nurse Ratched. Amy Morton portrayed Ratched in the 2001 Broadway revival. 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. Sarah Paulson portrays Nurse Ratched in Ryan Murphy's Netflix television series Ratched, a prequel to the One Flew Over the Cuckoo's Nest film, the first season of which debuted September 18, 2020. Isabelle JoLynn Murphy portrays a young Ratched.

Fletcher won the Academy Award for Best Actress for her portrayal of Ratched in the film. Ratched was named the fifth greatest villain in film history (and second greatest villainess, behind the Wicked Witch of the West of The Wizard of Oz) by the American Film Institute in their series 100 Years 100 Heroes & Villains.