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.