My professional career started in a regional hospital in south-eastern Ethiopia where no nurse had set foot before. I had to take a bus part of the way and a truck to reach the town as the roads were impassable in rainy season. The hospital had two expatriate doctors and several health assistants. Part of my duty included supervision of the health assistants. The hospital had never admitted inpatients, and it was functioning as an outpatient facility. The beds and the surgical equipment were locked in the store room. With my recruitment, the hospital was expected to admit patients and perform minor surgery as one of the doctors was a surgeon. We set up a medical and a surgical ward and an operating theatre, which was a testing experience for a newly graduated nurse. In this uncharted territory, it is inevitable that ethical challenges and dilemmas would arise. My first dilemma occurred when I was asked to assist in medical assessment of prisoners for ‘fitness for flogging’ or corporal punishment – a court order that must be complied with. The perplexing questions for me were as follows: should a doctor certify a patient ‘fit for flogging’? Can a nurse assist in such a procedure aimed at causing pain and suffering? Can medical assessment humanise the inhuman and cruel act of torture? I had a feeling of ethical distress that I was involved – albeit in an assistive role – in a procedure intended to cause pain and suffering to people, contrary to the ethical tenets of nursing, which affirm alleviation of suffering as a primary nursing responsibility. My second ethical dilemma in those early days was related to what we now call ‘task-shifting’ – in which tasks normally performed by a physician are delegated, or shifted, to nurses and those performed by nurses to less qualified health-care assistants. In principle, task shifting improves access to care and is desirable. Yet my training did not prepare me for diagnostic and prescriptive tasks. But in the absence of physicians, I had often to function beyond my scope of practice, particularly during night and evening calls. While ‘delegation’ has been a historical part of nursing practice, the tasks were not delegated to me based on my competence but by default because of lack of physicians. To make matters worse, my education in nursing ethics was limited and lacking in decision making. I realise now that while nurses in other parts of the world were facing complex challenges related to life and death issues such as euthanasia and end-of-life decisions, my ethical distress was related to everyday issues, including whistle-blowing, scope of practice, staffing levels and access to care, that could have been addressed with proper training in ethics and ethical decision making. I could easily trace my interest in nursing ethics back to those early days when I faced ethical dilemmas with no support or reference materials. Several years later when I had the privilege to lead the ethics portfolio at the International Council of Nurses (ICN), the nurse in the front line is always on my mind. That is why during my visits to health facilities, I often ask nurses about the ethical challenges they face in their day-to-day practice. I often ponder whether we are providing nurses with adequate training in nursing ethics and with tools and frameworks to help them make ethical decisions.