In Nurse Ratched , McMurphy had problems with her vocal cords .
However , due to McMurphy 's permanent damage to her vocal cords , Ratched 's cruel voice has been removed , rendering her unable to speak well , and requiring her to often resort to writing notes to communicate , which diminishes her control over the other patients. Nurse Ratched 's first name is revealed to be Mildred in the film version .
Nurse Ratched