This paper highlights the relationship between the Fundamentals of Care Framework, patient safety and quality improvement by describing a more holistic view of patient engagement across the healthcare system. By creating reliable and resilient healthcare organizations that enhance nurses' capacity to engage in relational care and vigilance, healthcare agencies can effectively achieve safety and quality aims. Integral to this is the nurse–patient relationship, whereby nurses know patient preferences for care and recognize when patients are deteriorating to prevent harm within the context of care environments.