It also requires way more nesting than it should, in my opinion. It would be nice to have a synchronous connect method so that I don't have to wrap my entire app in a connect callback.

And I don't see why 'collection' should take a callback either, unless you're in strict mode and querying mongo to see if it exists.

Some people have written higher level APIs on top of node-mongodb-native, two that I have seen are mongoose and mongous. I'm still evaluating them to see what their performance characteristics look like.