Healthcare organizations are embracing the sciences of safety, improvement, human factors, and complexity to transform their culture into a culture of safety and high reliability. Nurses are the front lines of healthcare delivery, and as such, the front lines of safety and quality processes and outcomes. Nurses are required to both understand and develop the skills needed to improve care processes and to own the work of improvement as a professional responsibility. These changes demand that nurses understand both the complex demands of providing harm-free care and the system dynamics needed to create the conditions for improved outcomes, organizational, and system performance, and intraprofessional development and teamwork. The author presents the challenge of maintaining a safe patient care environment and describes a model that can detect and mitigate the migration of safe nursing care into at-risk and unsafe nursing care. She emphasizes the importance of healthcare organizations performing as high reliability organizations and outlines 'planned practices' steps to introduce new technology and innovation, and concludes by considering the interaction between individual practice and system performance.