10 systems with dual CNO-COOs

Hybrid chief nursing officer and COO roles are gaining traction in healthcare as systems look to streamline operations and executive teams.

While there is no universal approach to C-suite design, some health systems are capitalizing on the natural synergies between nursing leadership and operational management through these dual roles.

Hybrid CNO-COOs can strengthen collaboration and care continuity within service lines while simplifying both strategic and operational planning. For smaller systems, the decision to merge these roles may also be driven by budget limitations and staffing constraints 

Below are nine hospitals and systems with dual CNO-COOs. 

Note: This is not a comprehensive list. If you have an addition, please email Mackenzie Bean at mbean@beckershealthcare.com

1. Jean Ten Haken has served as CNO and COO of Dartmouth Health's Alice Peck Day Memorial Hospital in Lebanon, N.H., since May 2019.

2. Crystal Farmer, MSN, RN, serves as senior vice president, COO and CNO of Fishersville, Va.-based Augusta Health. 

3. Bunkie (La.) General Hospital named Crystal Carriere, BSN, RN, as COO alongside her CNO role in 2024. 

4. Amber Egyud, DNP, RN, has served as CNO and COO of Chesapeake (Va.) Regional Healthcare since 2017.

5. Traverse City, Mich.-based Munson Healthcare appointed Cristen Brandsma, BSN, RN, as COO and CNO of two hospital campuses in April 2023.

6. Wilhelmina Manzano, RN, serves as group senior vice president, chief nursing executive and COO for perioperative services of New York City-based NewYork-Presbyterian. 

7. Kathryn Pagliaroli, BSN, RN, serves as senior vice president, COO and CNO at Oswego (N.Y.) Health.

8. Lacey Carter, MSN, has served as dual CNO-COO of Ozarks Healthcare in West Plains, Mo., since July 2024.

9. St. Luke's Jerome (Idaho) Medical Center promoted Kevin Watson, MSN, to the dual CNO-COO role in January 2024. 

10. Dignity Health's Woodland (Calif.) Memorial Hospital appointed Kara Estenson, DNP, MSN, RN, as chief nurse executive and COO in December 2025. 

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