It was a question a telehealth agent said they had been dreading.
“Are you a registered nurse?”
The question came in April from a couple nearing the end of their mandatory quarantine at a Toronto hotel, according to the employee. She said she was remotely supervising international travellers taking swabs for COVID-19.
The agent said it was part of her job for a subcontractor of Switch Health, a Toronto-based company tasked with managing Canada’s massive coronavirus border testing program as part of a nearly $100-million federal contract.
A Switch Health message informs travellers in a virtual waiting area that a “nurse will be with you shortly,” according to screenshots reviewed by Global News.
But in this case, the employee who said they assisted travellers was not a nurse and explained this clearly on the call.
“I feel horrible. I feel like I’m lying to people,” the employee told Global News in an interview. “I felt like an impostor.”
The employee is among six people who agreed to speak to Global News about their experiences with regard to the Switch Health government contract. They were all hired by a Toronto-based subcontractor called Blast Marketing.
Five of the employees who spoke with Global News allege they were told to identify themselves as a Switch Health nurse or nurse assistant, but they were not actually nurses. The other employee spoke about their experience as a customer service agent.
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An internal Switch Health training document titled “Telehealth Nurse Sample Script” provided to Global News also recommended that staff identify themselves as a “nurse” who will be “walking you through your at-home collection kit.”
Global News has agreed to protect their identities for fear of reprisals for revealing what they’ve seen about how Switch Health is managing its border testing contract.
Ontario, where the company is headquartered, has made exemptions for who can oversee the nasal swabbing process, according to the College of Nurses of Ontario (CNO) and it is not necessarily required that a medical professional oversee the test.
However, the college says it is illegal for anyone to practise nursing or use the title of nurse without a valid certificate of registration.
Those caught violating Ontario’s Nursing Act can face fines of up to $50,000.
Employees reached out to Global News following an earlier investigation, published in April, that revealed how hundreds of travellers had complained about Switch Health’s border testing program, describing long wait times, delays, missing test kits and clumsy mistakes. Global News confirmed they were hired by Blast Marketing through a review of employee contracts and an internal company directory.
Some of the employees also said they believed that Switch Health was “cutting corners” and failing to adequately train staff.
Switch Health declined to make any of its executives available for an interview.
But in a statement to Global News, the company admitted it was forced to change how it identified some employees after learning on May 12 that the title of “Nurse Assistant” was eliminated in Ontario in 1993 and that this title was replaced by “Registered Practical Nurse.”
“We immediately updated the title to ‘Generalist,’ ensured all employees and subcontractors were aware of the change, and informed the provincial government,” Jordan Paquet, vice-president of public affairs at Switch Health, said in an email. “At no point were any ‘Nurse Assistants’ or ‘Generalists’ instructed, trained or otherwise encouraged by Switch Health to identify themselves as nurses, nor are we aware of any record of this occurring.”
Paquet also confirmed that Switch Health had previously provided incorrect information to journalists by suggesting that only registered nurses were the ones doing remote supervision of swabbing.
He said that Blast Marketing has provided 29 staff to assist with “telehealth surges to ensure we see patients in a timely manner.”
Screenshots taken from the company’s website also appear to show changes that included removing the word “nurse.”
“We have updated the language in various materials to reflect this,” Paquet said in an email.
“All generalists work alongside our nursing team and have oversight by a registered nurse or registered practical nurse on our management team at all times. We should have been more specific in our earlier response to you and trust that the information above corrects the record and clarifies our response.”
Blast Marketing also declined an interview request, but confirmed in an email that it provided around 29 staff for telehealth to Switch Health and that it has “no knowledge of any statement indicating, nor any reason to believe, any team member is fraudulently presenting themselves as a registered nurse or registered practical nurse.”
“Blast Marketing has provided Switch Health with field operations, administrative staff, call centre support and some telehealth staff in surge periods,” the company said in a statement. “Our team does not falsely represent themselves as nurses or any form of medical professional.”
Blast Marketing also provided anonymous testimonials from two people the company purported to be employees. The testimonials said the employees were never asked to identify themselves as nurses.
‘Blind leading the blind’
The federal government awarded Switch Health its new contract after introducing new rules for non-essential international travel in February, including a requirement for two post-arrival COVID-19 tests for people crossing the border by land or arriving at the airports in Vancouver, Calgary, Toronto and Montreal.
Many of these tests are managed by Switch Health, but it is not the only contractor doing airport testing.
A promotional video on the Switch Health website — that shows travellers how to take their swab — explains that the company’s nurses are there to supervise swabbing.
“Please do not perform any of these steps without the verification of a nurse,” the video says.
The federal public health agency told Global News it was not aware of allegations some staff were identifying themselves as nurses without proper credentials.
“With respect to Blast Marketing, we have just been made aware of these concerns and are actively following up with the supplier to confirm that they are continuing to adhere to the standards established in their contract,” a spokesperson for the Public Health Agency of Canada told Global News in a statement.
Several weeks after hiring the telehealth staff, a Blast Marketing staffer appeared to direct a group of employees on May 12 to “immediately” refer to themselves as “TeleHealth Generalist” and to no longer refer to themselves as “TeleHealth Nurse Assistant,” according to a group text messaging chat reviewed by Global News.
It’s like “the blind leading the blind,” said another former Blast Marketing employee, who did not have any professional health-care training, but said they were also among those working in a role described by Switch Health as a “nurse.”
The Blast Marketing employee who told Global News that they felt like an imposter after being asked if they were a nurse said they completed just one hour of training to direct travellers through the anterior nasal swabbing process.
The employee said they were surprised to learn that Switch Health was referring to new staff members in her training cohort as a nurse.
“During training, one of the people leading the meeting referred to us as nurse assistants, which isn’t true either because that is a certification itself,” the employee said.
Switch Health previously said all testing guided by nurses
Paquet, the Switch Health spokesman, told Global News in his email responses that all nurses must provide their respective licensing prior to joining the team and that all testing is performed by either nurses or another qualified person, based on provincial guidelines.
Of the 1,189 employees currently working on its telehealth lines, he said, 1,172 were registered nurses, registered practical nurses or personal support workers (PSWs), and 17 were “‘generalists’ – many of whom have a background in health care as paramedics or dental hygienists.”
Paquet added that any suggestion that the company trains or encourages employees to state that “they are nurses when the employees do not have appropriate credentials or qualifications is categorically false.”
He noted that Ontario and other provinces, such as B.C., Alberta and Nova Scotia, allow anterior or front-of-nose nasal swabs to be performed by a non-health-care professional who has completed required training.
Two Switch Health executives are scheduled to appear at a House of Commons committee hearing on Friday to respond to questions about their government contract awarded by the Canadian government following an open competition in early 2021.
Doris Grinspun, chief executive officer of the Registered Nurses Association of Ontario, said any company that is misleading customers to believe they are speaking with a nurse when they aren’t is committing a “fraud on the public trust.”
“This is a company that should be investigated by the (federal) government,” Grinspun said.
“It makes me wonder how many more wrong things we have going on.”
Jennifer Jackson, a registered nurse and assistant professor at the University of Calgary’s nursing faculty, said in the rare case someone were to accidentally harm themselves during the swabbing process, an unqualified person might not know what to do.
“Someone can be shown how to do a nasal swab without being a registered nurse,” Jackson said. “But what if something goes wrong while they’re doing it? Does that person know how to respond?”
Paquet, the Switch Health spokesman, said the overwhelming majority of personnel on telehealth, 96.2 per cent, were registered nurses or registered practical nurses and that only 2.9 per cent of personnel on telehealth were non-medical professionals.
He also said all training manuals were developed in collaboration with the company’s nursing team and operations team.
“These materials were reviewed by the Public Health Agency of Canada as part of our competitive bid for the federal testing program,” he said. “We take patient and employee feedback seriously and use it to develop new product features and update our training program and manuals to improve patient experience.”
‘It’s pure madness’
Another Blast Marketing employee, who said they were hired to do customer service work for Switch Health, told Global News they decided to quit after a stressful two months on the job.
“Behind the scenes, it’s pure madness,” the former employee said.
Current and former employees described not having enough training to respond to questions, and three of them told Global News they often turned to a company chat on Microsoft Teams to figure out what to tell complainants.
“We just write into a group chat full of equally lost people,” the former employee said. “It’s all of us asking the same questions … like this is my client. What do we do here?”
The former employee said they received just one day of training before accepting calls from travellers inquiring about Canada’s quarantine rules and testing requirements and/or procedures.
“It’s like, ‘No, I can’t find your test. I don’t know how to follow up. I don’t know how to check if it’s in the lab or not. I don’t have access to the labs.’”
Paquet said Microsoft Teams is used to create a “team environment” while many of its employees are working from home.
“It allows them to securely speak among themselves during their shift to seek advice from their peers,” he said. “This allows everyone to have access to a team lead and support much like in a regular workplace.”
He also said the claim the company is “cutting corners” is categorically false.
“We ensure our employees are properly trained before they answer inquiries from travellers,” he said, adding that wait times for an appointment are now between “10 and 20 minutes.”
“As this program is continuously evolving, there is a need for ongoing training and coaching, which we provide our employees on a regular basis,” Paquet said.
He also said that Switch employs an “on-boarding team of human resource experts as well as individuals within our customer service and telehealth departments specifically for training our staff.”
The Public Health Agency of Canada told Global News on May 17 that over 520,000 coronavirus border tests for international travellers have been completed since Switch Health started its contract in February.
The federal agency also said that Switch Health reported taking 3.85 to 5.93 days on average to release results of the second post-arrival coronavirus test.
On April 23, the government changed its policy and started conducting post-arrival tests on day eight of quarantine instead of day 10. Since this change was implemented, roughly 99 per cent of post-arrival tests were completed before the quarantine period ended.
The agency also confirmed that during the first two months of the border testing program with Switch and other contractors conducting tests, 17 per cent of non-essential international travellers arriving in Canada have been forced to quarantine for more than the required two weeks since the new rules took effect.
As of May 12, nearly 6,000 test kits deployed by Switch and other contractors have had to be replaced due to invalid results, traveller error, or kits being lost or damaged
PHAC said under its contract with Switch Health the company “will not be held accountable” if travellers are responsible for this, but it didn’t specify whether the company would be required to cover costs of any of its own mistakes.
“PHAC has been working with Switch Health and federal government partners to increase access to kit registration, telehealth services and courier services,” a spokesperson said.
Switch Health has previously explained that it experienced some growing pains and hired more staff to meet growing demands, but that complaints represented a small fraction of all of its testing and that it had successfully identified thousands of international travellers with the coronavirus due to its testing.
The company, which only had a handful of employees at the beginning of the COVID-19 pandemic in 2020, now has hundreds of its own employees doing customer service, including about 800 nurses, according to an employee directory reviewed by Global News. Overall, Switch Health has over 2,000 people listed in its directory, reviewed by Global News.
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