The hospital is set somewhere in Oregon and the time period is the late 1950s or early 1960s. We know this in part because World War II is still a recent memory for Chief, but he’s been at the hospital for a while. The hospital is a small world of regulations, routine, and discipline ruled over by Nurse Ratched. Unlike in the outside world, Nurse Ratched has just about absolute control over her ward. In and of herself, she’s not that strong (which is what McMurphy tries to point out by exposing her bare chest), only in her setting does she have power. In the ward, she can bully, blackmail, and generally make life unpleasant for any staff members she doesn’t approve of until they quit. In such a way, she has gained a strong position of power, which is only strengthened by her ability to determine the fates of her patients – what kinds of medications and treatments they receive, including lobotomies. Nurse Ratched uses the close quarters of the ward to keep her patients docile and also to pit them against each other, further strengthening her rule.
Much of Nurse Ratched’s power is centered in the setting of the ward and keeping out the Outside world. When McMurphy shows up, one of the tools he utilizes to undermine her is to change up the setting of the book. He’s a breath of fresh air for the patients and essentially a taste of the Outside and freedom. Since Nurse Ratched tries so hard to keep the Outside out of her ward, McMurphy is a huge threat. One way or another, McMurphy tends to instigate changes of scenery. He manages to get a new day room for the Acutes in an old tub room, away from Nurse Ratched’s music and watchful eye. He also gets the Acutes and Chief out on a fieldtrip to go fishing. He even takes Nurse Ratched’s own setting – the ward – and completely transforms it into a party zone. These changes of setting help the patients of the ward escape some of Nurse Ratched’s domination and fear she has instilled in them. In the end, because of McMurphy, Chief is able to instigate a change of scenery for himself, and he escapes the ward completely.