Amanda Skenandore sets The Nurse’s Secret in 1883, during America’s Gilded Age, a period of rapid industrialization and extreme wealth disparity. New York City was a landscape of stark contrasts, where the lavish mansions of industrialists on “Millionaire’s Row” (40) stood in sharp opposition to the squalid tenement districts of the Lower East Side. Jacob Riis, a pioneering photojournalist, documented the grim reality of neighborhoods like the Five Points and the Bowery in his 1890 work How the Other Half Lives (1890), revealing overcrowded, unsanitary conditions that bred poverty and disease. His photographs “highlighted the greed of factory owners and managers, and the cultural neglect of the slums that led to immigrants and laborers living in such conditions” (“How the Other Half Lives.” Theodore Roosevelt Center, 23 Oct. 2025.) This environment shapes the novel’s protagonist, Una Kelly, who “survived by hustling” (21) after the death of her mother and abandonment of her father. She also experiences another result of social stratification: a sophisticated criminal underworld where she is part of a network of thieves, or “divers,” who rely on fences like Marm Blei to sell their stolen goods. This system mirrors the organized crime prevalent in 19th-century New York, which operated with the complicity of a notoriously corrupt police force. A key tool of law enforcement during this era was the “rogues’ gallery,” a collection of photographs of known criminals. Una often fears being identified from this gallery, which she knows is displayed at police headquarters.

Amid the wealth disparity and rise of crime was also the emergence of professional nursing in America and specifically the Bellevue Training School for Nurses which had just opened in New York City. Prior to the 1870s, nursing was not considered a respectable profession. Hospitals relied on untrained and often illiterate caregivers, including formerly incarcerated individuals conscripted from workhouses (Author’s Note, 354). This began to change with the founding of the Bellevue program in 1873, “the first school in the United States to be run according to Florence Nightingale’s nursing principles” (“Bellevue Schools of Nursing.” The Lillian & Clarence del La Chapelle Medical Archives). The school aimed to transform nursing into a disciplined and honorable profession for women, emphasizing hygiene, order, and moral character. This standard is articulated by Superintendent Perkins during Una’s interview: “A nurse must be industrious, disciplined, intelligent. No matter the circumstances, she must perform her duties with calmness, exactitude, and efficiency” (86). This professionalization created an opportunity for women seeking independence and a respectable livelihood. However, admission was highly selective, typically restricted to educated, unmarried Christian women of good social standing. Una, a poor, Irish Catholic grifter, is the antithesis of the ideal applicant and must forge documents to gain entry. For her, the school’s rigid structure and standards make it the perfect hiding place from the police, who would never suspect a wanted criminal could infiltrate such a prestigious institution.