The leadership at St. Luke’s International Hospital and its nurse training program were very vocal about being a state of the art medical facility that sought through its nurse training program to raise the quality of nursing education and practice in Japan. They very clearly sought to reproduce American styled nursing education at St. Luke’s. To achieve this they brought nurses from the United States to teach and manage the nurse training program and brought Japanese nurses from Japan to the United States for post graduate studies and observation experiences. This study examines the tensions that exist at the intersections of a foreign Episcopal Church mission project, Rockefeller Foundation philanthropy, and the development of nursing in Japan. This study uses historical methodology and is a transnational study. A theory of Critical Transnational Feminism (CTF) is used to consider issues of race, class, and gender at St. Luke’s International Hospital and School of Nursing in Tokyo, Japan in the early twentieth century. The collaboration between Japanese nurses, physicians, and board members with American missionary nurses and doctors to lead and develop a world class medical center and school of nursing provides an opportunity to probe issues of power based on gender, race, and class. The CTF lens calls attention to the tendency of transnational history to often be Western-centric and has provided a framework to go deeper into an equitable representation of transnational studies. This study has found that lay medical missionaries prioritized their professional goals over the Christianizing goals of the church. The study reveals that power in the transnational space was a shifting and contested quality. Although Japanese and American actors at St. Luke’s talked about cultural diplomacy the relationships that they had were still hierarchical across race, gender and professional boundaries. Nursing at St. Luke’s represented progressive professionalization movements for women for both Japanese and American nurses. Nurses who traveled had elite social opportunities because of the associations that they had in their international work. Finally, St. Luke’s was uniquely positioned to develop public health nursing in Japan and they had significant impact in that area.