Basically what you need to do is follow Hospital policy regardless of what you think. Another thing to do is also check the policy of AORN which for most is considered the gold standard of nursing operating room practice. As long as you are following hospital or AORN standards you are fine. If you don't, well you are ripe for an attorney later. Remember, it is YOUR license on the line because the surgeon will blame THE NURSE or the SCRUB. If this continues to happen, you might need to report it to your manager if you can't address the surgeon personally about this. Something other hospitals have done is to not pass closing suture to the surgeon until your first count is done, but that can be a problem. Other hospitals have mandated an x-ray on all open cavity patients regardless of if the count is correct. Counts also go faster if your scrub is organized. It's a scrubs
responsibility to keep track of instruments that go into the patient, so if one is missing it is the scrub who has not kept track very well. I can say that because I used to be a scrub. But I agree that any time you have a count that is off, it is an event and needs to be reported. If it is not reported, your surgeon will continue to ignore counts.
Just remember to always follow hospital policy and you won't be involved in a trial and suddenly be with out a license. Also if an event happens, DONT talk to anyone about what happened. Since anything you say to someone else can be used in a court against you. As can what you write. So also be careful about the notes you keep after an event.