Gather initial thoughts and broad opinions about the book.

1. How did the blend of historical fiction, mystery, and romance work for you as you were reading? Did one of these genres feel more dominant than the others in shaping the story?

2. Amanda Skenandore often writes about marginalized voices in forgotten corners of American history. For those who have read her other work, like The Second Life of Mirielle West (2021), how does Una’s story fit with the author’s broader themes?

3. The novel vividly portrays the stark contrasts of Gilded Age New York, from grand mansions to squalid tenements. How did this setting shape your overall reading experience and your perception of the characters’ motivations?

Encourage readers to connect the book’s themes and characters with their personal experiences.

1. Una lives by a strict set of personal rules, like looking out for herself. Did her adherence to and eventual breaking of these rules resonate with you in any way?

2. Una finds her calling unexpectedly when she becomes a nurse to hide but finds genuine purpose in the work. Can you think of a time when a practical necessity in your own life led to an unexpected passion or discovery about yourself?

3. Consider friendships you have experienced. What do you think is the most important element that allowed Dru and Una’s friendship to form despite Una’s initial cynicism and secrecy?

4. Characters like Nurse Hatfield and Dr. Pingry make judgments based on class, religion, and gender. Have you ever felt underestimated or misjudged based on external factors? How did Una’s methods of navigating prejudice strike you?

5. What does the concept of a “found family” mean to you, and where did you see it most clearly in the story?

6. Edwin is drawn to Una because she challenges the “correctness” he’s used to in women of his social standing. What qualities do you find most compelling in people who are different from you or who challenge your perspective?

Examine the book’s relevance to societal issues, historical events, or cultural themes.

1. The Bellevue Training School was founded to make nursing a respectable career. What does the novel’s depiction of this historical shift tell us about the opportunities and limitations for women in the 19th century? How has society’s perception of the nursing profession shifted since then?

2. This guide notes the influence of Jacob Riis’s photojournalism on our understanding of the Gilded Age. In what ways does a fictional story like Una’s give a personal face to the societal problems that journalists of the era were trying to expose?

3. How does the novel’s historical depiction of a corrupt police force and a failing justice system compare to contemporary conversations about social inequality?

Dive into the book’s structure, characters, themes, and symbolism.

1. Una utilizes disguise to shift her identity and survive in a brutal world. What other characters use disguise or deceit? Why?

2. There are many characters that could be considered antagonists in the novel: Connor McCready, Marm Blei, Nurse Hatfield. Why might Skenandore include so many people who oppose Una?

3. Inspired by Edgar Allan Poe’s detective fiction, the story has a strong mystery element. In what ways does the novel follow the conventions of a classic mystery, and in what ways does it subvert them? Skenandore could have referenced any other mystery writer. Why is Poe a good choice for The Nurse’s Secret?

4. Una’s descriptions of Bellevue Hospital and the nurse’s home contrast sharply. What is the significance of this distinction between settings?

5. Skenandore’s portrayal of Gilded Age New York focuses on the city’s underbelly. How does this perspective compare to other literary depictions of the era, such as in Edith Wharton’s The Age of Innocence (1920)?

Encourage imaginative and creative connections to the book.

1. The novel ends with Una accepting an unofficial training role. What kind of nurse do you think she becomes two years later, after the story ends? Describe a scene showing her on the ward, using the skills she’s learned from both the street and the school.

2. Superintendent Perkins offers Una a second chance, but it’s an unconventional one without a diploma or pin. You’re a member of the Bellevue board. Design a new, alternative training program for promising but unconventional candidates like Una. What would its core principles be?

3. Dru sees Una as “uncommonly brave and true of heart” (295) and proves to be a loyal friend. Recreate Dru’s meeting with Superintendent Perkins about the death of Mr. Knauff. What else does she say about Una? How does she react to being expelled?