Over the last 10 years, numerous political drivers have paved the way for the development of new and innovative models of practice within the critical care environment. Many of these new models of practice required practitioners to perform detailed and comprehensive patient assessment. Within critical care, respiratory assessment is increasingly regarded as an essential element of a critical care practitioner's profile. However, the assessment of other body systems has been adopted more slowly. This article argues that skin and nail assessment should be ascribed a high priority within practitioners' scope of practice. The skin is the largest organ in the body. A wide range of diseases covering numerous pathologies and specialities manifest in changes in the skin and nails. There has been increasing realization and recognition that there is a connection between the skin and systemic disease. The skin and nails can therefore give valuable diagnostic clues to underlying disease. This article offers practitioners an opportunity to develop and augment their knowledge and understanding of skin and nail assessment and its application to the critically ill patient.