For example: the MongoDB libraries for Node gave us many problems. I won't go into the specifics as that would take a while, but switching to Ruby mongo driver along with the Mongoid ORM resulted in a huge increase in code readability and is much more reliable I think.
Also being able to use amazing Ruby libraries like devise/omniauth are a big win I think. Similar with Jammit, Barista, Rspec, the list goes on. Here's our current Gemfile: https://gist.github.com/68f0326a9480266d462e. Some of these libraries have Node.js equivalents, but they are all very early stage.
That said, most of our code is UI side anyways. For that I'm using coffeescript / jquery / backbone.js. We'll probably reintroduce some small, focused Node.js server components in the future for the most highly accessed http requests as we start to ramp up the traffic.