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The book focuses less on black nurses' efforts and experiences as care givers than on black responses to racism in health care and the health professions in the era of Jim Crow.The first half of the book examines the history of black hospitals and nurse-training institutions in the United States, covering black-run voluntary hospitals created when mainstream hospitals barred black patients and physicians, white-run hospitals caring for black patients, and the all-black nursing schools connected with them and with black colleges and universities.

I have been in the situation where a married woman, never used to wear her ring and I never knew until the last moment and I said 'no I can't do this'," Bolt said.

Hine has delved deeply and imaginatively in published and archival sources and recent works in nursing history.

Her work has a breadth and analytical focus lacking in previous histories of African Americans in nursing, all written by insiders.

Hine shows the impact of racism on black nurses, yet her relentless focus on institutions and a tendency to adopt, rather than explain, the points of view espoused by their leaders obscures two important topics: the nursing experience of black women in white (relegated mainly to one chapter late in the book) and their distinctive response to racism. Black hospitals and nurse-training schools need to be compared with other local black organizations, the NACGN in its successive phases with other national race-betterment and protest organizations and with other professional nurses' organizations.

Placing the NACGN in those two contexts might help explain its unusual decision to disband.

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"I have tried my best to keep it on a certain level.

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