Purpose Delirium is common in older patients admitted for in-hospital treatment of vascular dysfunction. In the absence of effective pharmacological treatment, nursing management is essential. The purpose of this study (Enabling Nurses to Recognise and manage the Impact of Cognitive impairment in Hospitalised patients) is to explore nurses’ experience of recognising and managing patients with delirium. Methodology Nurses from two acute aged care wards and one neurology ward in a Sydney metropolitan tertiary referral hospital were invited to participate in a semi-structured interview, of which eleven nurses agreed to participate. The interviews were recorded and transcribed verbatim. Data was analysed qualitatively by applying the principles of human factors as an interpretative lens. Results Multiple human factors principles were identified with an intersection of workplace, management, and people related factors. All participants reported high levels of capability in the recognition of delirium and the importance of knowing about behavioural disturbances and their impact on the patients, families, and clinicians. Many participants identified concerns related to management with inadequate workforce allocation, need for multiple modes of workforce capability development which was challenged by limitations in the provision of mentorship, and excessive workloads. Most had experienced difficulties in delivering patient-centred care particularly when the family were excluded. Conclusion Nurses who care for inpatients with delirium identified strong capability in the recognition delirium but experienced difficulties in management. Nurses reported there was a lack of time to care and a lack of recognition of the burden of care. There was an overwhelming sense of responsibility with many describing moral injuries. These understandings of recognising and managing delirium in geriatric patients needs to be integrated into the care of patients admitted and undergoing treatment for vascular dysfunction.