This isn't the answer you're looking for, but personally, I feel like
IDE's can get in the way a lot more than they help. I definitely
prefer a lightweight editor. SublimeText is definitely my current
favorite. But, Joe/Andrew is right, dynamic language development
necessitates a comprehensive testing suite.
That said, I don't think that a tool capable of supporting some of the
things you want is out of reach. For instance, Jetbrains has WebStorm
which supports NodeJS including debugging and refactoring. However,
I'm not sure how good it is for Node development, I think it's more
targeted at client side web development. They also have RubyMine for
Ruby. Also, word on the street is that C9 is working on some
refactorings too.