Aim The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges. Background Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multi-level factors need to be considered to promote changes in practice. Method Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7-S model was used as an a priori framework to categorize the perceived challenges and solutions. Results The nursing managers identified a number of organizational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles. Conclusion This study highlight the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed. Implications for Nursing Management Understanding the challenges and identifying possible solutions can help hospital staff provide better person-centred dementia care.