This chapter describes the pervasive nature of monitoring and improving quality and managing breakdown in nursing practice. The role of prevention of complications of hospitalization and promotion of patient safety has been central in nursing education and practice long before the current Institute of Medicine (IOM) focus on the massive proportions of patient safety issues in current hospitals and long term care facilities. It is important to tell stories of breakdown and stories of moral suffering because in them lie some of the most highly valued notions of good patient care. The contrast cases in the chapter are examples of strong disharmonies in practice. The instability and even crisis in current healthcare systems create an opportunity to redesign our systems to facilitate best practice.