It is 1892 and most young women from poor immigrant families have little choice about their futures. Many spend long days working in crowded garment factories, earning just pennies a day. Most are expected to marry and produce children while helping family businesses and caring for aging relatives. Only a lucky few are selected to enter nurses' training in New York City's Lower East Side during an era of mass immigration.

Eighteen-year-old Rosa Campo is the daughter of Italian immigrants and one of the lucky few chosen to train to become a nurse. While she progresses through her professional journey to save the life of an abandoned newborn and grieve with an older Jewish man whose wife passes away unexpectedly, Rosa befriends another student, Jade Ling, born in America to Chinese immigrants. As they learn to step from rooftop to rooftop when caring for poor patients who live on the least expensive top floor, Rosa and the other nurses diligently work to fulfill their dreams of healing and changing the world by advocating for healthcare for the underserved.

Stepping Over Rooftops is the historical tale of a young Italian nurse trainee's journey into adulthood as she works alongside patients, teachers, and other students to contribute to the promise of America through healthcare.