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Nursing Leadership Presence

Nursing Leadership Presence


In the show, One Flew over the Cuckoo’s Nest, Nurse Ratched was portrayed as a villain. She was a soft-spoken, cruel, cold-hearted, emotionally detached, non-caring head nurse of a psychiatric institution in a pristine white uniform who lacked most, if not all of the five elements of emotional intelligence: self-awareness, self-regulation, motivation, empathy, and social skills (Chamberlain College of Nursing, 2021). Her leadership style in controlling the ward was dependent on her use of covert manipulation and psychological torture. By her lack of self-awareness and social skills, she sees herself as helping her patients and not the evil her patients perceive her to be.

 In two scenes in the show, Nurse Ratched through her lack of self-awareness, self-regulation, empathy, and social skills threatened and humiliated a young psychiatric patient Billy, in front of other patients who appeared to have just had a sexual encounter with a female patient that she would report him to his mother. She also displayed these traits when despite Billy begging her not to tell his mother, she calmly and adamantly refused to order Billy to be confined to the psychiatrist’s office immediately instead (Netflix, 2020). Again, all these being displayed in front of all the patients. Through her calmness and soft-spoken voice, she genuinely appeared to be helping Billy meanwhile her attitude displayed her lack of self-awareness, self-regulation, social skills, and empathy instead.

This threat of telling Bill’s mother about his encounter culminated in Billy first having a complete emotional breakdown and ultimately killing himself. This incidentally drove Billy’s friend Murphy into a complete rage.  Nurse Ratched upon finding Billy’s dead body, rather than show some empathy, care, or love instead ordered that the patients return back to their daily routines. Her lack of empathy, self-awareness, self-regulation, and social skills towards Billy’s death drove Billy’s friend Murphy into a complete rage leading to him strangling Nurse Ratched (Mortimer, 2013).

            As a Nurse leader, unlike Nurse Ratched, who threatened to report Billy to his mother for his actions, I’ll lead with emotional intelligence with change agent characteristics. I’ll have good judgment, strong communication skills, respect for Billy and other patients. I will listen to Billy, talk with him respectfully and privately without judgments rather inspiring positive behavior in him. I’ll gain Billy’s trust and the trust of other patients by keeping our conversations confidential without reporting or threatening to report to their parents. Despite Billy being confined to a mental institution, he’s still an adult, a human being with dignity, rights, and deserving of respect.

            Nurse Ratched’s ward is influenced by chaos theory. The ward is disorganized without order, it’s unpredictable and sometimes out of control. There’s no chain of commands with hierarchy, protocols, or policies. Rather it is totally dysfunctional with nurse Ratched possessing all the power and the authority. The complex, unexpected, undesirable, unpredictable, non-linear, and sudden results of a chaos theory (Demir et al., 2019; Öztürk & K?z?lkaya, 2017) was in full effect when Murphy out of his rage for Nurse Ratched’s total lack of emotional intelligence after Billy’s suicide almost straggled and killed Nurse Ratched with other patients actively observing.


 Chamberlain College of Nursing. (2021). NR-703 Week 2: The Emotionally Intelligent Leader [Online lesson]. Adtalem Global Education

Demir, M. S., Karaman, A., & Oztekin, S. D. (2019). Chaos theory and nursing. International Journal of Caring Sciences, 12(2), 1225-1228.

Mortimer, A. (2013, May 23). One flew over the cuckoo’s nest – Nurse Ratched strangle scene. [Video]. YouTube. Retrieved March 5, 2021, from

Netflix. (2020, September 19). Who is Nurse Ratched? The story of the ultimate villain. [Video]. YouTube. Retrieved March 5, 2021, from


Öztürk, Z., & K?z?lkaya, S. (2017). Chaos-complexity theory at management. International Online Journal of Education and Teaching, 4(3), 259-264.


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