Amanda Skenandore’s 2022 historical novel, The Nurse’s Secret, is set in 1883 New York City against the backdrop of the Gilded Age. The story follows Una Kelly, a cunning young grifter from the slums who is forced to flee after being implicated in a murder. To evade the police, she cons her way into the Bellevue Training School for Nurses, the first of its kind in the United States. While hiding in plain sight, Una must navigate the rigid social and professional hierarchies of the school, grapple with a series of suspicious deaths, and confront her own past. The novel explores themes including The Performance of Social Class and Identity, Finding Redemption Through Caregiving, and The Intersection of Deception and Authenticity. Known for historical fiction that focuses on marginalized voices and forgotten corners of American history, Skenandore adds this novel to those she has already penned, including Between Earth and Sky (2018), which won the American Library Association’s Reading List Award for Historical Fiction, and The Second Life of Mirielle West (2021).

This guide refers to the 2022 Kensington Publishing Corp. trade paperback edition.

Content Warning: The source text and this guide contain depictions of graphic violence, illness or death, substance use and addiction, cursing, sexual harassment, death by suicide, religious discrimination, and gender discrimination.

Plot Summary

In 1883 New York City, a skilled grifter named Una Kelly successfully pickpockets an unsuspecting man at Grand Central Depot by staging a collision. While he helps her gather her intentionally scattered belongings, she steals his silver cigarette case and some cash. Shortly after, Una observes a young boy get caught trying to steal a gold watch. She intervenes, pretending to be the boy’s aunt and convinces the victim to let him go.

Her actions backfire when she discovers the boy has stolen the watch again. When a bystander points her out as the culprit, a police officer chases Una. She escapes by ducking into an alley, changes her appearance, and successfully fools the officer.

On her way to the shop of her boss, Marm Blei, Una encounters a reporter, Barney Harris. He is investigating a possible connection between the recent strangling murders of a man called Big-nosed Joe and a sex worker named Martha Ann. Una reaches Blei Dry Goods, a front for a fencing operation, where Marm Blei expresses displeasure over Una’s close call at the depot and relegates Una to work in the back room the next day.

Unhappy with Marm Blei’s control, Una goes out that night. At a dance hall, Una steals ruby cuff links from a wealthy man. Deciding to assert her independence, she plans to sell the cuff links to a rival fence, Traveling Mike Sheeny, which violates Marm Blei’s strict rules. However, Deidre, Una’s roommate, follows her and discovers her plan, demanding 50% of the profits. They go to an alley to meet Traveling Mike, but as they arrive, they witness him being strangled by a man in a dark suit and cap. The killer escapes. As a screaming Deidre and a panicked Una flee the scene, a second officer blocks the alley’s exit and apprehends Una.

At the police station, a corrupt officer named Simms frisks Una, confiscating her belongings and pocketing the ruby cuff links for himself. When a telegraph confirms the murder, Simms stops Una from leaving and places her in a cell. Deidre is brought in shortly after and held separately. A detective interrogates Una, then reveals that Deidre has betrayed her by pinning the murder on her. The cuff links, which Simms had pocketed, are then produced as evidence against her. Marm Blei visits Una in jail but refuses to provide bail or legal help, abandoning her for her disloyalty.

While being transported in a police wagon, Una creates a diversion, kicks Officer Simms in the face, and escapes. She hides in an old Catholic cemetery and picks the lock on her handcuffs. Now penniless and a fugitive, she seeks refuge with her estranged cousin, Claire, who reluctantly allows Una to hide in her cellar.

Then, after reading an article about the new Bellevue Training School for Nurses, Una plans to hide by becoming a nurse trainee, a place no one would look for a criminal. She enlists Barney Harris’s help to forge a school record and a letter of reference. During her trip to see Barney, she reads a newspaper article detailing her escape and describing her as a “violent and cunning” (78) con woman.

Una attends an interview at the nursing school with the superintendent, Miss Perkins; a board member, Mrs. Hobson; and a hostile head nurse, Miss Hatfield. Despite Miss Hatfield’s prejudice against Una’s supposed Catholic faith, Una’s fabricated story of charity and her determined spirit convince Miss Perkins to accept her into the program. Una moves into the nurses’ home, which is clean and comfortable, and meets her cheerful and talkative roommate, Drusilla “Dru” Lewis.

Assigned to a surgical ward under Miss Hatfield’s supervision, Una is frequently chastised and is even sent to Superintendent Perkins, who gives her a stern warning but allows her to stay. Later, Una identifies a patient’s delirium tremens and gives him brandy, angering the pompous surgeon Dr. Pingry. A young intern, Dr. Edwin Westervelt, covers for her. During a surprise anatomy exam given by Dr. Pingry, Una cheats and passes, but she steals Dr. Pingry’s watch in retaliation for his unfair grading.

Una deduces that the second-year trainee, Nurse Cuddy, is pregnant, a secret that would lead to her expulsion. Una covers for her by taking her place in the operating theater in exchange for favorable reports. Meanwhile, Dru confesses she has hemophobia. To help her, Una arranges for them to observe a blood transfusion with Edwin’s help. In return, he asks Una to meet him at Central Park, where they talk and  go ice-skating. Eventually, they kiss, beginning a secret romance.

After passing her probation, Una learns of a suspicious “suicide” in the “Insane Pavilion,” where a woman supposedly hanged herself with a belt that is now missing. Soon after, Deidre is brought into the hospital drunk and recognizes Una. She blackmails Una for money and a near-empty bottle of laudanum. The next morning, Deidre is dead from a supposed overdose. At the morgue, Una sees bruising on Deidre’s neck, but the pathologist dismisses her suspicion of strangulation. Still feeling connected to Deidre, she bribes the morgue keeper to prevent Deidre’s body from being sent for dissection and accompanies the coffin to potter’s field on Hart Island.

Grieving, Una confesses her suspicions about Deidre’s murder to Dru. Inspired by Edgar Allan Poe’s detective stories, Dru convinces Una they should investigate together. They sneak into the ward for those with alcohol addiction and examine Deidre’s former cell, concluding the killer likely works at the hospital. Una then steals the pathologist’s notes from the morgue, which reveal inconsistencies about Deidre’s body, including broken fingernails, strengthening their suspicions.

A patient, Mr. Knauff, dies after an intern, Dr. Allen, administers ether without knowing the patient had recently eaten. Summoned by Superintendent Perkins, Una panics and blames Dru for failing to report that the patient had not fasted. Soon after, Una learns Dru took full responsibility and has been expelled despite contracting typhus. Una is allowed to stay. Later, the death of a patient under Dr. Pingry’s care triggers painful memories of her mother’s death. While grieving on a balcony, Una is comforted by Edwin. She is about to confess her past when she is summoned because Nurse Hatfield has accused her of theft. During a search of her room, they find Dr. Pingry’s watch, and Una is expelled.

Homeless and broke, Una sits in a cheap restaurant when the sound of an ambulance bell triggers a memory of Traveling Mike’s murder. She realizes the “belt” around his neck was an ambulance tourniquet and the killer was the ambulance driver, Conor McCready. After Edwin refuses to help her because she lied about her identity to him, she goes to Barney Harris for help, and they devise a plan to trick Conor into confessing.

Una convinces Conor to accompany her to a lodging house, pretending a woman there has identified the Bellevue killer. In the room, Una taunts Conor to provoke a confession while Barney hides. Realizing it is a trap, Conor locks the door, discovers Barney, and stabs him repeatedly with a trocar from his medical bag. Una fights back, but Conor begins to strangle her with his tourniquet. Just before losing consciousness, Una injects Conor with a syringe of morphine from the medical bag, and he collapses.

Una awakens in a Bellevue ward. Edwin had followed them to the lodging house and broken down the door, saving her and Barney. With statements from Edwin and a recovering Barney, the police clear Una of all charges. Superintendent Perkins offers Una the chance to continue her training unofficially, without a diploma or pin. Una visits a recovering Dru and confesses her entire past. Dru forgives her and affirms their friendship. Later, Edwin finds Una on the hospital lawn. He apologizes for not believing her and asks for a second chance. Una agrees, and they begin their relationship anew.