The Christie Charity
Press release posted 9 May 2025
After more than 3 decades at The Christie, advanced practitioner Karen Johnson is preparing to retire this year. Her clinical expertise and patient-centred care are deeply valued by the oncology gynaecology team and by her patients.
As one of the first nurses at The Christie to take up an advanced practice role, Karen has not only witnessed the transformation of oncology nursing but also helped shape it. She has blended clinical excellence with innovation to lead service development and enhance patient care.
When Karen joined The Christie in 1991, oncology care looked very different. Radiotherapy patients often stayed in hospital for long periods, and the idea of advanced nursing practice was just emerging. Now, as one of the hospital's longest-serving advanced practitioners (APs), Karen reflects on a career that evolved alongside and helped influence significant changes in cancer care at The Christie.
Karen has spent most of her working life at The Christie, and her ties extend to her family. Her husband worked at the hospital in the 1990s, and 2 of her sons are now employed at the Trust; Samuel in haematology staffing and Dominic in engineering.
"It’s been a big part of both my personal and professional life," Karen says. "It means a lot to know that even as I step back, the connection carries on through my sons."
Her journey mirrors the evolution of cancer nursing at The Christie, from traditional ward roles to leading-edge advanced practice. Karen’s commitment to patient-centred care, team development, and continuous improvement has benefited her colleagues and countless patients.
Early career and the path to advanced practice
Karen began nursing in 1990 after completing her BN/RGN nursing degree from the University of Wales College of Medicine, Cardiff. She first worked on a ward at Wythenshawe Hospital, but her determination to work in oncology brought her to The Christie in 1991. Starting in Ward 6 (male radiotherapy), then moving to Ward 1 (female radiotherapy), and after completing an oncology nursing course, moving to surgical oncology in Ward 10, she quickly found what she enjoyed.
From the outset, Karen’s approach extended beyond traditional clinical care. She conducted audits and research, explored the information needs of carers and nurses, and worked on projects like patient rehabilitation and pressure sore prevention.
"I was fortunate to find the area I wanted to work in early on," Karen explains. "It gave me great early career opportunities to build a role I love."
That drive led to a Master’s in Advanced Practice at Liverpool University, which became a springboard for her pioneering new role.
"When I returned in 1996, I became the first advanced nurse practitioner at The Christie," says Karen. "I wanted to show that nurses and allied health professionals could challenge professional boundaries and expand their roles to truly enhance patient care."
Innovation in gynaecological oncology
Karen built her advanced practice role within the clinical oncology gynaecology team, supporting women with cancers of the cervix, uterus, vagina and vulva.
"Survivorship issues like menopause, sexuality and bone health are really important," she says. I’ve always been interested in the late effects of treatment and how we can support or prevent them. Combining medical expertise and holistic care are critical in achieving this.
“When I first started, hormone replacement therapy (HRT) was rarely offered to younger women after their cancer treatment had induced menopause, even if they had no risk factors. Now, it’s standard practice. Advanced practitioners can make that kind of change - we see a gap and act."
Karen’s work is rooted in the 4 pillars of advanced practice: clinical expertise, leadership, research and education. She has spoken at national and European conferences, sat on national advisory panels, participated in research and peer-reviewed academic work, led clinical audits, mentored trainees, and supported the education of future APs. More recently, her focus has returned to direct patient care and developing a sustainable team for the future.
"Until 2017, I was the only nurse in the team," Karen recalls. "Now we have an AP, a trainee AP, clinical nurse specialists, and a cancer care coordinator. Helping build that has been one of the most rewarding parts of my role."
Supporting patients throughout their journey
Karen is often the first clinician a patient will meet at The Christie and can remain their point of contact throughout treatment and follow-up, sometimes for 5 years or longer. Her consultations often replace those traditionally conducted by doctors.
"Patients appreciate the continuity," she says. "They don’t have to repeat their story each time. Once they understand the AP role and our training, many request to see us instead of a doctor."
Supporting patients - Jane’s story
One patient who has experienced Karen’s invaluable support is Jane Graney, age 45, from Swinton. The active mum, who is a research nurse, found she had a persistent cough and was getting breathless when out running. A keen marathon runner and triathlete, she went to see her GP in September 2024.
Jane, who is married to Mike and mum to Martha and Imelda, initially assumed the cough was just the lingering effects of a virus. However, routine blood tests revealed low iron levels, which failed to respond to treatment, prompting further investigation.
As months went on, Jane began experiencing weight loss and abdominal pain. A scan at the end of January 2025 revealed a mass on her cervix, and she was diagnosed with stage 3c(i) squamous cell carcinoma of the cervix. She was referred immediately to The Christie, where a treatment plan was put in place at the end of February.
Starting in March 2025, Jane underwent five weeks of radiotherapy on weekdays combined with weekly chemotherapy, followed by three sessions of brachytherapy over two weeks.
“Mike and the girls have been amazing throughout my diagnosis and treatment, says Jane. “And Mike, my mum and friends rallied round to bring me to my daily appointments.
“Treatment was not easy. Radiotherapy, particularly the first 2 weeks, was painful. Drinking 600ml of water before each treatment to position my bladder correctly was a daily challenge. Fatigue and loss of appetite made those early days even harder. However, by week 3, my pain eased, my energy levels began to rise, and the chemotherapy became more manageable.”
Throughout her treatment, Jane was supported by Karen Johnson. She first met Karen during a particularly difficult week when she was struggling with weight loss, pain, fatigue, and the overwhelming nature of so many appointments, including needing a blood transfusion.
“Karen was a lifeline,” says Jane. “She gave me time when I needed it most. I was tearful, low, and scared I wouldn’t be able to continue my treatment. Karen listened patiently, reassured me, and made sure I was physically able to carry on with chemotherapy.”
Karen also worked with Jane and her husband to find practical ways to improve nutrition despite the common metallic taste caused by treatment. Understanding that Jane thrived on activity, Karen encouraged her to stay mobile, go to the gym or run, and adapt exercise to her energy levels, helping Jane retain a sense of normality.
One special memory stands out for Jane, her daughters’ cheerleading competition. “I didn’t think I could go,” she explains. “Karen suggested a plan to help me attend. Thanks to her, I was there to watch them perform. It meant everything.
“Karen’s approach to care was holistic and personal. I felt heard. She was finding solutions and making sure I could live life, not just endure treatment and the side effects.”
Reflecting on her experience, Jane said: “The Christie is such a calming, well-organised place. Every member of staff works to make a daunting experience a little easier. And Karen, with her knowledge and encouragement, who always listened and never rushed me, played a huge role in getting me through all the treatment.”
For patients like Jane, the support of advanced nurse practitioners is invaluable, as they provide expert medical care, emotional reassurance, and, most importantly, treat every patient as a whole person, not just a cancer diagnosis.
The growing role of advanced practitioners in modern oncology
Today, The Christie has 75 qualified APs and 26 in training, supporting almost all clinical areas. The AP career pathway is now open to all health professionals, not just nurses.
"Until APs were introduced, the only constant for patients was often their consultant," Karen says. "Now we provide that continuity and specialist support for years."
She explains how The Christie’s vision for AP roles developed partly due to the European Working Time Directive, which reduced junior doctors' hours. "It created an opportunity for upskilled nurses with advanced skills, and The Christie embraced that because it provided the continuity of care our patients valued."
Following a change in the law in 2006, Karen recalls how The Christie became one of the first hospitals to allow nurse prescribing across all medicines, including chemotherapy and controlled drugs. "Before that, I had the knowledge, having studied pharmacology, but not the authority. It was frustrating. Being able to prescribe meant I could provide better care."
Changes in cancer care
Reflecting on changes in nursing care, Karen notes the move from in-patient to ambulatory care. "When I started, most treatment was in hospital. Now, it’s mostly outpatient-based, although cases can be more complex, with patients living longer, often with co-morbidities.”
"Advanced practice helps us innovate to meet demand while staying patient-focused. It’s not about replacing doctors; it’s about expanding what care looks like, filling the gaps between traditional doctor and nurse roles."
Karen also highlights the success of the HPV vaccination programme. "20 years ago, I’d see several women every year under 25 with advanced cervical cancer. We haven’t seen a single case in the last decade. That’s prevention in action.
“However, rising obesity has seen endometrial cancer cases more than double during my career, and it is now the most common gynaecological cancer we treat. It shows how important prevention and research still are."
Looking ahead
As Karen plans her retirement, she isn’t leaving entirely. "I’ll stay linked with The Christie through bank work in education and digital learning. There may be clinical opportunities too - we’ll see."
Her advice to aspiring APs is: "Don’t rush. Get broad experience over at least 5 years of your early career, try to learn one new thing every day and learn to look after yourself. And the key is to listen to patients - they’re our greatest teachers.”