The reform of hospital nursing in the last quarter of the nineteenth century brought nursing leaders into conflict with the gendered and class bound structure of Victorian society. The experiences of Maria Machin are used in this article as an example of the barriers nursing leaders had to overcome in order to establish a competent nursing service. While Machin was eminently successful in improving patient care and expanding the knowledge base of her nurses, she could not change the perceptions of nursing which the public at large held. At the beginning of the nineteenth century hospital nurses had been essentially cleaning women who gave some of the less important nursing care. They formed a cheap service which many hospital governors considered a relatively low priority in the overall operation of the hospital. This view of nursing persisted long after the reformers had made nursing into something quite different. Machin's nursing career also illustrates how nursing participated in a major aspect of British imperialism, the export of professional expertise and administrative skills as well as the way nursing fitted into the rise of the new professionalism.