In the wake of Nurse Raymes' departure, Patsy De La Serda, a new supervising nurse, 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. Nurse Dawn and Patsy get off on the wrong foot, but it's soon evident that there is a special spark between them. Donna, a more docile patient, wins DiDi's affections and displays impressive karaoke skills.

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.