However, a review of European studies showed that isotretinoin was prescribed in full accordance with the pregnancy protection programme in 6–26% of cases, resulting in pregnancy rates of between 0.2 and 1.0 per 1000 women of childbearing age using isotretinoin. Contraceptive failure caused 30% of the pregnancies (Crijns et al, 2011). When prescribing a potential teratogen is unavoidable, nurses need to counsel women about the risks and benefits, and ensure the patient adheres to any restriction. Finally, nurses need to remain alert for accidental occupational exposure to teratogens and carcinogens. For example, learning disabilities may be more common among children of nurses who handled antineoplastic drugs (Connor and McDiarmid, 2006). Furthermore, a Canadian study found that nurses who had worked in a cancer centre or oncology nursing unit were 83% more likely to