It's July 4th at the Billy Barnes Extended Care Unit of Mt. Palms Hospital. On her first day of work, nurse DiDi Ortley discovers feces on a lounge chair, and is torn between the conflicting orders of veteran nurse Dawn Forchette, who wants to file an "incident report" before removing it; temporary medical director Dr. Jenna James, who is in need of a stool sample for her medical study; and supervising nurse Beverly Raymes, who has had endemic issues with floor cleanliness and wants the seat sterilized. In a heated argument with Nurse Raymes, Dr. James has a public meltdown and ends up permanently assigned to this dead-end job. Meanwhile, the staff tries to determine the identity of an Asian woman who was found wandering on a highway, and debate what to do with a deceased patient's birthday cake.

In the wake of Beverly’s departure, a new (male) Supervising Nurse, Patsy De La Serda, joins the Billy Barnes staff with a customer-centric, "cruise-line based" agenda that he’s convinced will improve ward ratings. Patsy soon learns that managing patients – especially highly uncooperative and feisty ones like Varla – isn't necessarily improved through customer-service metrics. On the other hand, a more docile patient named Donna wins DiDi's affections and displays impressive karaoke skills.

DiDi ends up in "conflict resolution" after Patsy files a grievance against her for inappropriate remarks. Dawn learns that intimacy with a co-worker is no guarantee of evaluation immunity. Dr. James and Patsy go head-to-head when she decides to skip the "Make Someone Happy" orientation to attend a Cleveland medical convention. A patient, Birdy, sends shock waves through the ward when her gentleman caller, Leonard, and she are caught in a romantic agenda. Patsy announces a ward-wide deep cleaning.

Dr. James decides to implement a geriatric exercise program in the ward, upsetting Patsy, whose "Make Someone Happy" initiative now includes a live pianist and a fountain. DiDi discloses Patsy's relationship with Dawn to her union rep as proof that her homophobic comment wasn't serious. A homeless woman, and her accompanying stench, is suspiciously dumped in the ward, prompting a staff investigation. Phyllis arrives to check on her dying mother. Dawn wins the grand prize in Dr. James' charity raffle. Dr. James considers relocating after learning she must re-apply for a job she never wanted in the first place.

DiDi's serene evening shift is turned upside down by the arrival of a new Swedish - speaking patient and several unwelcome inebriated visitors. Stopping by after a lamentable dinner party, Dr. James attends to her drunken husband Richard's ingrown toenail while dreaming of a Cleveland fresh start; a woozy Dawn looks for stopgap comforts in the lounge after an unsettling evening with Patsy; and an elderly Swedish tourist shows off her gymnastic chops while complaining about her ruined vacation.