Organizational routines embody the stability-change duality: for routines to be consistent, actors performing them must improvise to adjust to changing conditions. While these interdependent aspects are often intuitively navigated by organizational actors, sometimes they can manifest as contradictory, paradoxical requirements. Using a paradox lens, this paper explores how individuals deal with tensions as they oscillate between preserving and altering routines. Building on an ethnography of an emergency room, we unpack routine dynamics and identify three tensions with paradoxical attributes: learning vs. efficiency, flexibility vs. compliance, and autonomy vs. control. When triggers render tensions salient, organizational members rely on three responses (avoiding, shrinking, and stretching) to deal with tensions while performing routines. Based on these findings, we contribute to the routines and paradox literatures by discussing how routines are used as rubber bands in balancing tensions.