The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa. Through critical ethnography, this paper describes the manifestation and impact of moral distress as experienced by central Ugandan nurses providing care to HIV-infected or -affected people. Participants described their passion for nursing and commitment to patients and experienced moral distress when a lack of resources put patients’ wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make.