A modern view of Nurse Ratched

Image: Warner Bros.

I kind of thought that Nurse Ratched of “One Flew Over the Cuckoo’s Nest” got a bum rap. Until, of course, the last part of the movie when she starts berating Billy by playing the “what will your mother think?” card.

Back in 60s psych wards, there were no counselors who held the group therapy sessions over which Nurse Ratched presided. Shock therapy and/or lobotomy was the usual treatment for extreme depression, suicide attempts, psychoses, and neuroses. The antipsychotics and antidepressants which we now take for granted did not exist.

The depiction was from an era before most modern nurses were even BORN.
A lesser nurse could not have dealt with a unit instigator like Jack Nicholson’s character. Ratched was strong enough to calmly but firmly keep her all-male unit on a schedule (something that certain psych diagnoses need), collaborate with the MD and expect her staff to do their jobs!

Fast forward to 1977: (Future) Nurse Rene is sitting in her psych nursing class with an absolutely phenomenal instructor (who not only has a master’s degree in nursing, but also a huge amount of clinical experience with patients in state institutions and war vets).

So, off the class goes, all fresh and full of textbook knowledge about neuroses and psychoses, on our way to the locked ward in an acute care urban hospital. We are all in street clothes, with only lab coats to distinguish us from the patients.

Our assignment is ONLY to talk with patients and write down what they say. We are not to attempt to treat anyone, give meds, or do any nursing care. We are, however, to report anything like suicidal expressions to the RN in charge.

We sit down at a table with a couple of patients who are sewing leather purses. Cigarettes are handed out only in the day room by staff members for those patients who have smoking privileges. (Obviously this event goes back quite a few years!)

Suddenly, there is a loud crash just behind me. One of the patients hits the floor, face-up, and another stands over him, pumping his chest, shouting, “Breathe! Breathe!”

We looked at each other wondering what to do (and not to do!) in this situation. Finally, one of the staff members comes out from behind the glass-enclosed nurses’ station and pulls the patient up from the floor. He then explains to us: “John does this often just to get attention.”

This all made for a very interesting post-clinical discussion.

Nursing is nothing if not interesting and unpredictable…

“Let us consider that we are all insane. It will explain us to each other; it will unriddle many riddles…” Mark Twain

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