Purpose: Frontline employees frequently experience tension at work. Based on paradox theory, this study investigates why and when tension can result in positive performance outcomes and for whom tension can enhance creativity. Design/methodology/approach: We employed a time-lagged survey design to collect data in two waves with a four-week interval between waves. The questionnaire was distributed to frontline employees (i.e. doctors and nurses) serving in one public hospital in Ho Chi Minh City. The final sample included 216 front-line employees. Findings: The study found that tension can promote employee performance through creativity. Employees with high paradox mindset levels especially tend to be more creative when experiencing tension. However, our findings did not support the idea that frontline employees who have been psychologically empowered tend to turn creative ideas into real practices and result in better employee performance. Originality/value: The study advanced knowledge of the effect tension has on employee performance by investigating the mechanism through which experiencing tension can ultimately promote employee performance.