Canada opened the scoring with a power play goal from Marie-Philip Poulin at 6:23 but the USA was able to tie the game before the period came to a close, courtesy of Abbey Murphy.
In the second period, the teams traded goals in the first 10:00, with Brianne Jenner scoring for Canada and Hilary Knight potting one for the USA. Canada took the lead before the middle frame came to a close as Jenner was able to net her second of the night at 19:39.
In the third period, American Caroline Harvey evened the game up at 3-3 early on and after a tightly-contested battle for the majority of the period, the USA was able to take over in the final stretch.
Knight gave her country the lead at 16:40 and then completed the hat trick less than a minute later, both goals coming on the power play. Cayla Barnes scored the empty-netter to ice the win for the USA.
Shots were 27-22 for Canada. The game snapped Canada's gold medal run at two, with wins coming in 2021 and 2022. Canada has won gold 12 times at the tournament.
Johnston is a Team Canada veteran with 14 international tournaments to her name. She made her international debut in 2008, winning silver at the World Championship and has captured gold five times in her career: the 2010, 2014, and 2022 Winter Olympic Games, and the 2012 and 2021 World Championship.
The 33-year-old is currently a member of Team Scotiabank with the PWHPA and was recently named a Forward Of The Year candidate after a strong performance throughout the 2022-23 season. In 13 games, she netted nine goals and 18 points.
