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This paper aims to highlight the need for the traditional concept of nursing skill mix to be reconfigured within a new concept of skill matching.Substantive literature describes staff deployment and patient-dependency models. However, limited information exists as to what informs decision making regarding nurse skill assessment and subsequent patient allocation in intensive care units.In intensive care units, nurse numbers, available nursing skills and patient allocation decisions, impact directly on care provision and outcomes. This paper argues that staffing decisions that are based on insufficient knowledge which lack consideration of all pertinent factors result in poor ‘skill matching’, potential adverse events and poor outcomes. A critical inextricable link exists between staffing decisions, patient safety and risk in the intensive care unit. Use of a multifactorial skill-matching approach within a dedicated staffing decision-support system is recommended.This commentary paper adds a new perspective to nurse-staffing decision practices and their relationship to risk management in the intensive care unit and offers a new research direction.