Twenty Years: The American Academy of Nursing and the Institute of Medicine in Perspective Elaine Larson, RN, PhD, FAAN Janet Heinrich, RN, DrPH, FAAN Enriqueta Bond, PhD Both the IOM and the AAN strive to provide visionary leadership to the nation for health care and health policy. A comparative analysis of their memberships, priority setting and planning processes, and resources is used to make recommendations for the future direction of the Academy. M ore than 20 years ago, health care leaders in the United States were implementing changes in our health care systems resulting from the legislation that created Medicare, Medicaid, community health centers, and other health and social programs. The focus then was on how to provide high-quality services to older popula- tions and the poor. At that time there was also a perceived need to bring dis- tinguished scholars together to study the issues and problems that affect society and the public's health. The American Academy of Nursing (AAN) and the Institute of Medicine (IOM) were both established in the early 1970s during a period of dramatic changes in our health care system, in the science undergirding our knowledge of human diseases, and in our social values. Today, we in the United States face NURS OUTLOOK 1995;43:105-11. Copyright © 1995 by Mosby-Year Book, Inc. 0029-6554/95/$3.00 + 0 35/1/57722 increasingly pressing problems concern- ing the health and well-being of our population. Two of the most critical challenges to the nation's health care system are how best to provide access to appropriate, high-quality, and affordable health care for all people and how to contain the growth of health care costs as a percent of the gross domestic prod- uct. The AAN and the IOM share a commitment to providing forums for dis- cussion of the critical issues we face as we develop new approaches to resolve the public health problems of today and the future. The AAN and the IOM also share certain missions and objectives (Box 1), and both have memberships comprising leaders in health care. Both organizations are responsible for provid- ing input into the direction for the health care of the nation, but they have very different organizational capabili- ties. There are also many differences between the two organizations that in- fluence the scope and focus of their work. The purposes of this article are to de- scribe the history, missions, organiza- tional structure and composition, and scope of activities of the IOM and the AAN; to compare the membership, pri- ority setting and planning process, and resources of the two organizations; and to make recommendations specifically to the Academy that might enhance its effectiveness in fulfilling its mission. THE AAN The AAN was established in 1973 by the American Nurses Association (ANA) Board of Directors. This fol- lowed the 1964-66 House of Delegates action to establish an Academy of Nurs- ing for the advancement of knowledge, education, and nursing practice. In the first report back to the ANA House of Delegates, the following objectives were noted: • To identify and explore issues in health, in the professions, and in so- ciety as they affect and are affected by nurses and nursing. • To examine the dynamics within nursing, the interrelationships among the segments within nursing, and the interaction among nurses, as all these affect the development of the nursing profession. • To identify and propose resolutions to issues and problems confronting nursing and health, including alter- native plans for implementationJ Fellows of the Academy were to be se- lected by the Governing Council from among members of the ANA who had NURSING OUTLOOK MAY/JUNE 1995 Larson, Heinrich, and Bond 105