Hybrid chief nursing officer and COO role 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 9 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. Traverse City, Mich.-based Munson Healthcare appointed Cristen Brandsma, BSN, RN, as COO and CNO of two hospital campuses in April 2023.
2. Amber Egyud, DNP, RN, has served as CNO and COO of Chesapeake (Va.) Regional Healthcare since 2017.
3. Dignity Health’s Woodland (Calif.) Memorial Hospital appointed Kara Estenson, DNP, MSN, RN, as chief nurse executive and COO in December 2025.
4. Mount Pleasant, Texas-based Titus Regional Medical Center tapped chief nursing officer, Kathy Griffis, RN, to also serve as COO in a dual role.
5. 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.
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. Magnolia (Ark.) Regional Medical Center named Stephanie Schmittou, MSN, RN, COO alongside her CNO role in August 2025.
9. Ascension Via Christi in Wichita, Kan., appointed Erika Troutman, MSN, RN, as CNO and COO of Via Christi St. Teresa and Via Christi Rehabilitation Hospital in July 2025.
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