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AFN Impact: Taking Forensic Nursing to the Coroner's Office

Written by Dr. Kathleen Thimsen, AFN Treasurer

Have you ever thought about what happens after you prepare a patient and release their body to the morgue? Well, Dr. Annette Cannon, a forensic nurse in Colorado, made learning that her mission. Cannon spent most of her professional life providing care for persons across the life to death continuum with that burning desire to find out what happens at and after the morgue.

The journey to becoming a coroner began for Cannon as a forensic psych nurse in an outpatient setting. She then transitioned into forensic psych nursing in a correctional facility. She was also involved in teaching nursing in a baccalaureate program in Denver. After several years in the forensic psych setting, she saw a position for coroner in Jefferson County, Colorado. The county reports a population of approximately 650,000 people in its 774 square mile area. It is the fourth largest county by population in Colorado, and the second-busiest coroner office in the state. Being the second-busiest coroner’s office relates to the actual death rate being so high. In 2022, the county death rate numbered 202, compared to the state total of 5,714 deaths. The leading cause of death in Jefferson Co. was cardiac, followed by respiratory-illness-related deaths, closely followed by alcohol-related deaths at number three.

It turned out that the posting that interested her was an elected position, requiring Cannon to first campaign and win an election. The job meshes public health and public safety roles, with health and criminal justice being important aspects that play a heavy role in death investigation—determining cause of death while working with law enforcement and the next of kin to the deceased. Her work was cut out for her. Not being a politician, she had to quickly learn to determine a party affiliation, grasp how the political landscape works, and manage fundraising for a campaign. She also needed to develop skills such as advocating for herself, and being comfortable with telling people why she was the best person for the job. She additionally had to complete state and county background checks, hours of training, and gain party support for the campaign, while knowing the actual job was going to involve bi-partisan positioning and support. To prepare herself for the position, Cannon became a member of the International Association of Coroners and Medical Examiners (IACME) and is Board Certified in Death Investigation (ABMDI-BC).

Cannon discussed the barriers and obstacles to her campaigning which centered around the fact that she had no law enforcement background or legal experience. She was a forensic nurse! At the end of the campaign, the people selected Cannon as the first nurse-coroner because she was a nurse, and the public respected that fact and knew she was up to the job.

Her daily work involves managing operations of a 12-person office, all the financial aspects of running an office on a strict budget, handling human resource matters, creating and executing contracts, and building relationships across the county while creating an office environment that puts people first and is driven by compassion, teamwork, and professionalism. She noted that her staff is now able to advance within the organization through a career ladder for which they receive feedback, support, and resources to bolster their professional goals. She proudly noted that during her tenure the office achieved the IACME’s Accreditation, no easy feat for a 12-person corner office.

Cannon’s work is 24/7 as she is always available even when she’s not on call. Current projects and campaigns that she’s focused on include community education around organ and tissue donation, as her office handles the process when a resident dies. She spearheaded updates to the electronic death record. She is engaged in teaching about death and dying with Dever schools of nursing through work with simulation on death scenarios. Cannon discussed the necessity of hosting a “mass fatality drill” with the airport, and she is working on generating an overdose fatality review process and committee. The office has two forensic pathologists and autopsy techs on contract to fulfill autopsy needs as they arise. The death investigators do the lion share of the work.

She is very proud of her office and the staff as they accomplished “Achieving Excellence in 2023” with rewards for performing at a higher professional level. To support her staff, she has made available a trauma counselor to improve the resilience of the staff. Cannon exhibits high ethical standards and a dedication to improving the coroner’s office in Jefferson Co. during her last term in office, which ends in 2026.

Cannon has demonstrated nursing excellence and dedication to improving the office and the growing her staff’s professionalism through her use of nursing skills and expertise in systems management and operations, along with versatility and the psych-mental health competencies of working with families and persons affected by violence and trauma. She is another example of forensic nurses leading the way and creating opportunities for professional development and growth.

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