Many emerging applications of hexagonal boron nitride (h-BN) in graphene-based nanoelectronics require high-quality monolayers as the ultrathin dielectric. Here, the nucleation and growth of h-BN monolayer on Ru(0001) surface are investigated using scanning tunneling microscopy with a view toward understanding the process of defect formation on a strongly interacted interface. In contrast to homoelemental bonding in graphene, the heteroelemental nature of h-BN gives rise to growth fronts with elemental polarity. This can have consequences in the different stages of film growth, from the nucleation of h-BN magic clusters and their sintering to form compact triangular islands to the growth of patchwork mosaic monolayer with a high density of misfit boundaries. The parallel alignment of triangular islands on the same terrace produces translational fault lines when growth fronts merge, while antiparallel alignment of islands on adjacent terraces produces non-bonded fault lines between domains terminated by like atoms. With these insights into the generation of void defects and fault lines at grain boundaries, we demonstrate a strategy to obtain high-quality h-BN monolayer film based on step flow growth.