The article discusses Ludwig Wittgenstein’s theory of conceptual competence within the area of nursing ethics. Wittgenstein’s analysis shares fundamental assumptions with virtue approaches to ethical dilemmas in caring practice but is at the same time crucially different. The main difference is that while virtue theories have focused on psychological attitudes like compassion and empathy, Wittgenstein focuses on a person’s understanding of concepts like good and wrong. According to Wittgenstein, an ethical competence in nursing is not equivalent to knowledge of moral principles that are understood independently of contexts of application. But Wittgenstein is also opposed to the view that it is contextual knowledge that provides the normative basis for caring. For Wittgenstein, an ethical competence is essentially a preconception awareness of how caring concepts apply. According to this analysis, nurses should address ethical dilemmas in patient interaction by focusing on their understanding of ethical concepts in the context of interaction. Case studies are used to clarify this and other practical implications of Wittgenstein’s position.