Ruby is introduced as part of the show's increased focus on paramedics and producers wanted to explore the profession through the character.

Ruby clashes with paramedic Iain Dean (Michael Stevenson) and was integrated into his story about post-traumatic stress disorder (PTSD).

The story develops in a Casualty-Holby City crossover event, "CasualtyXHolby", where Ruby finds Iain after he attempts suicide.

The story leads to the character's departure from the serial and she exits in the thirty-first episode of series thirty-four, originally broadcast on 18 April 2020.

[1] Lucy Raffety, the show's series producer, was pleased about Hill's casting and expected her to be a "massive hit" with the audience.

[4] She told Sophie Dainty of Digital Spy that she liked playing characters that she would not befriend in real life as it challenges her as an actress.

[3] Hill initially found that the gory scenes made her "light-headed" but soon calmed when she realised it was a jam-like substance used to create the fake blood.

[3] The actress told Allison Jones of Inside Soap that Ruby is "very textbook" and her "obsession" with rule-following often lands her in trouble.

[8] Hill felt that Ruby's near-photographic memory of textbooks challenged her as it meant she could not improvise her lines at risk of messing the order of the medical terminology.

Paramedics typically recite the patient's medical state using written notes, but Ruby's near-photographic memory means that she remembers everything.

[3] She added that the NHS needs people immediately due to how overstretched it is, so Ruby believes that she can "hit the ground running".

Raffety thought this would be "both heartwarming and heartbreaking",[9] and explained that Ruby provides an "immediate experience of what it's like to be out on the rig and be part of this slightly dysfunctional paramedic family".

He and Hill discussed the possibility of a romance and concluded that it would not work due to the characters' age gap and difference in personalities.

[23] He added that although Ruby notices Iain is acting strange, their previously "volatile relationship" meant that she felt that she could not ask him personal questions.

[27] When Iain decides to leave for a job with the Helicopter Emergency Medical Service (HEMS), Ruby and Jan are initially conflicted about whether it is a good decision.

[34][35] The story and Hughes' guest stint concludes when Ruby finds Dani about to operate on a patient, having claimed to be a paramedic.

[39] Further information was revealed on 26 November 2019 when actress Kelly Gough's casting as Violette Spark, the estranged sister of Ruby, was announced.

[46] A show insider explained that Ruby believes that Harmony will be "enough to make Violette realise that she had to kick the habit for good".

Her colleague, Lev Malinovsky (Uriel Emil), gives her advice on how to approach the situation and offers support from him and his wife, nurse Faith Cadogan (Kirsty Mitchell).

After being offered drugs by her ex-boyfriend, Violette accepts, but when she later awakens, she is horrified by her actions and realises that Harmony's temperature is high.

[44] Ruby asks paediatric consultant Will Noble (Jack Nolan) to speak to Violette about Harmony's symptoms and he diagnoses a dangerous form of meningitis, which could be fatal if not treated fast.

[52] Her exit storyline begins following Violette's death, when Ruby's mother, Lavender Spark (Sian Webber), is introduced.

Another visit from Lavender makes Ruby question herself and consequently, she decides to give her parents custody of Harmony, afraid of failing her.

[54] Ruby's exit is sparked from learning that her parents are moving abroad with Harmony, prompting her to realise she made an error.

[58] Radio Times critic Alison Graham called Ruby "a tiresome by-the-book sort",[59] and the "over-earnest new paramedic" who is "learning how to be a functioning human being rather than a rule-spouting automaton".

[59] She also branded her a "hopeless dork" who is "weepy and miserable",[60] "bovine",[61] and the "dopey sidekick" of Iain,[62] The reviewer dubbed her first shift "disastrous".

She commented, "She's completely compelling to watch and she makes Ruby touching and relatable as a young paramedic struggling with the harshest of realities.

[70] Tasha Hegarty from Digital Spy called the episode "emotionally-charged" and thought Violette's death created a "sad ending" to the story.

"[50] She praised Hill's performance and thought she portrayed Ruby's mixture of being upset and being professional as she watched the medics try to save Violette well.

[73] Hegarty (Digital Spy) noted that viewers were "sad" about Hill's departure, but pleased that she received a "happy ending".