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.

In the season finale, Phyllis gets the runaround as her mother's condition worsens, improves and worsens again. Jenna tries to leverage her Cleveland opportunity into concessions from Dr. Stickley. DiDi's patience wears thin after a debt remains unpaid. Staff members point fingers at each other after an equipment malfunction injures Cordelia, an irascible patient. The staff makes up when a patient dies and comes together to perform their weekly Caregiver Concert for everyone in the ward.