It's July 4th at the Billy Barnes Extended Care unit of Mt. Palms Hospital in Long Beach, CA. On her first day of work, Nurse DiDi Ortley discovers feces on a lounge chair, and is torn between the conflicting orders of unit 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 stool samples for her medical study), and Supervising Nurse Beverly Raymes (who has issues with floor cleanliness and wants the seat sterilized). In a heated argument with Beverly, Dr. James has a public meltdown, and ends up being permanently assigned to this dead-end job. Meanwhile, the staff tries to determine the identity of an Asian woman 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 agenda he's convinced will improve ward efficiency. Patsy soon learns that managing patients--especially a highly uncooperative, un-medicated one named Varla--isn't necessarily improved through customer-service metrics. On the other end of the spectrum, a more docile patient named Donna wins DiDi's affection and displays impressive karaoke skills.

Patsy files a grievance against DiDi for remarks he deems inappropriate - Dr, James decides to go to a convention in Cleveland - a patient is caught in a romantic situation with her gentleman caller - Dawn gets evaluated with no exceptions.

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 her homophobic comment wasn't serious. A homeless woman, and her accompanying stench, is suspiciously dumped in the ward, prompting a staff investigation. 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 in the ward is turned upside down after the arrival of a new 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.

Phyllis' mother's condition vacillates; Jenna attempts to get Dr. Stickley to make concessions; DiDi grows impatient when a debt is unpaid; an equipment malfunction injures a patient; the staff perform their caregiver concert.