With a week to go before Twin Cities nurses could walk off the job in a massive strike, doctors are rescheduling surgeries, patients are reworking their calendars and everyone in the health care community is studying the lessons of previous nursing strikes.

Pregnant women due in July are calling their doctors for reassurance that all will go well. Some Twin Cities doctors are gearing up to work with unfamiliar nurses. Others are applying for privileges at non-strike facilities.

Hospitals, meanwhile, are making every effort to reassure patients that they will get care if they need it.

"I'm worried about the community," said Dr. Thomas Schmidt, chief of patient safety for Park Nicollet, which owns Methodist Hospital in St. Louis Park. "I'd hate for someone to sit at home with a heart attack and not come in."

Most physicians said they expect the system to operate smoothly -- after a period of adjustment.

Some 12,000 nurses from 14 hospitals are set to launch an open-ended walkout Tuesday that could go down as the biggest nurses' strike in U.S. history. A 24-hour strike by the same nurses last month failed to get hospitals to budge on their contract proposals. Talks resumed Tuesday, with the two sides clashing over staffing, wages, pensions and benefits.

As before, the hospitals are expected to stay open by hiring replacement nurses, mostly from out of state.

Learning from June 10

During the 24-hour walkout June 10, the Minnesota Department of Health reported no major problems. The department sent six monitors out to the hospitals. "Nothing caused us to feel we had to do any immediate intervention," said Darcy Miner, director of compliance monitoring. "We were satisfied that patients were safe."

An open-ended strike, though, has bigger potential to disrupt care.

Doctors say they expect the first week or two to be the toughest, as replacement nurses familiarize themselves with the hospitals. After that, they say they expect things to operate as usual.

Dr. Marty Immerman, an obstetrician at Paul Larson OB/Gyn Clinic in Edina, delivers babies at Fairview Southdale Hospital. "We had no disasters or problems in 2001," Immerman said, referring to a previous strike at the hospital. "The replacement nurses were quite competent. Delivering a baby in Georgia and delivering a baby in Minnesota is the same."

Doctors will have to work harder at communicating what they need to the nurses, he said, but "the nurses are not going to do anything against medical practice."

Still, he acknowledged that some of his patients are worried: "Most patients come to us already anxious -- they're pregnant."

Some patients, he said, may want to put off procedures such as hysterectomies, but "me being a doctor, I don't think it's an issue. The surgery is the same. It's a collaborative practice between nurses and physicians."

Dr. Kevin Graham, president of the Minneapolis Heart Institute at Abbott Northwestern Hospital, said the cardiac care unit there -- one of the largest in the state -- would be operating at full capacity. "When you are running a world-class heart organization you can't shut it down long term," he said.

Because of the holiday weekend, the hospital's census will be low anyway on Tuesday morning, giving everyone the opportunity to ramp up care slowly if necessary, he said.

The state's physician organization, the Minnesota Medical Association, has not taken a stance in the nurses' contract dispute.

"Physicians in Minnesota are interested in the best patient care," said MMA chief executive Dr. Robert Meiches. "We believe the parties need to come together on behalf of the patient."

Getting up to speed

At Twin Cities Orthopedics, the state's biggest orthopedics practice, many procedures are already done in outpatient surgery centers and won't be affected by the nurses' strike.

Doctors may postpone some hospital-based elective procedures until they're comfortable the replacement nurses are up to speed, said the group's president, Dr. David Holte.

Some surgeons have also gotten credentials at day surgery facilities that won't be affected by the strike, said administrator Troy Simonson.

As with orthopedics, many cancer treatments previously done in hospitals have migrated to outpatient centers. That might mitigate some of the effects of a long strike.

"We saw some fairly minimal effect" during the June 10 walkout, said Dr. Thomas Flynn, president of Minnesota Oncology, the biggest oncology practice in the state.

In a longer strike, some patients who get chemotherapy at hospitals may be diverted to one of Minnesota Oncology's outpatient centers, but "I don't think it's going to have a large impact on our day services," said Randall Thompson, executive director of Minnesota Oncology.

"I just hope [the nurses and hospitals] find a middle ground," Thompson said. "On a global basis, it's mutually assured destruction if they don't come to an agreement."

Staff writer Josephine Marcotty contributed to this report.

Chen May Yee • 612-673-7434