I have just started working at a Medical center, after recently moving to the area. I am still on orientation, and was orienting on a Total Abdominal Hysterectomy. It was change of shift and the RN precepting me had to leave. Another nurse came in to watch over me until the end of the shift. The original preceptor had done the original instrument count at the beginning of the case. After a while, the scrub person had to leave as well and her relief came in to relieve her and they initiated a change of shift count. The 2nd preceptor, had me to do the sponge and instrument count with them. Everything was fine until we got to the laheys, and the long allis clamps and there was 1 extra of each of them on the case, that never got counted in the first place, because they weren't strung together properly when packaged in the tray. (I have heard that this has been a problem for some time, and that all the scrub techs are complaining because the count sheets either don't match whats in the tray, or the stringers are not strung together in groups properly, making counting everything a nightmare.) I made the scrub tech mad because I informed the surgeon that we were over on our instrument count by 2 clamps, and asked him what he would like to do, he was mad, but did a thorough inspection of the abdominal cavity and pronounced that he was fine with the count the way it was. I still had questions, at the end of the case, so I informed the charge nurse, who told me that they never worry about it if they are over on an instrument, so long as the surgeon is ok with it. This still bothers me, because everyone seemed so non-chalant about it. My question is do I make the Director of Surgery aware of this matter, and do I fill out a Risk identification report about it. The initial scrub tech was very angry at me, however, I feel that they have put my RN license at jeopardy, if I do nothing about the matter. This scrub tech in question, hates to do instrument counts and often goes over my head to the director if I call her out on something. I don't want to make enemies at my new place of employment, but I want to be a good patient advocate, because I would hope that someone would care enough to do the same for me if I was the patient.