YES, you definately need a formal program with a preceptor. The OR environment is totally different from the floor. You need to develop your critical thinking skills i.e. labs etc. I also feel a new RN needs to have the experience of calling an MD at 3am for a tylenol order! Or learning to have the chart right in front of you and knowing your patient so you can give an intelligent answer to obnoxious questions. Otherwise you will get eaten alive! Having been through a great 6 month training program then moving to a hospital that trains in-house was a great trial of my patience. The techs think they run the room and the RN's haven't developed the assertiveness they need for the responsilbility they shoulder. Not to mention the amount of equipment, postioning etc. you need to learn.