This article analyzes the tensions evolving from project management dilemmas and how they relate to stakeholders in large technology projects. The study addresses an organization-wide electronic health record implementation in a large hospital. It adopts a duality lens in exploring whether and how these tensions materialize through stakeholder voices. In contrast to traditional linear and unitarist thinking in project management, duality thinking may lead to project management practices that acknowledge, appreciate, and accommodate the tensions originating from dilemmas inherent in complex projects. We propose three stakeholder roles that can contribute to project managers' tension awareness and inform duality management.